Provider Demographics
NPI:1487739488
Name:UTLEY, STEPHANIE (SLP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:UTLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 LAKE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8007
Mailing Address - Country:US
Mailing Address - Phone:817-550-5058
Mailing Address - Fax:817-550-8177
Practice Address - Street 1:216 LAKE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76087-8007
Practice Address - Country:US
Practice Address - Phone:817-550-5058
Practice Address - Fax:817-550-8177
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80T581OtherBCBS
TX147819002Medicaid