Provider Demographics
NPI:1487305629
Name:WIMSATT, STEPHANIE KAY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KAY
Last Name:WIMSATT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1258 BURD AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2106
Mailing Address - Country:US
Mailing Address - Phone:812-593-7471
Mailing Address - Fax:
Practice Address - Street 1:2019 CENTER ST STE 203
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2358
Practice Address - Country:US
Practice Address - Phone:216-282-1582
Practice Address - Fax:216-927-1801
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist