Provider Demographics
NPI:1588148357
Name:STEPHENSON, CARLEE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARLEE
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 BONNIE BRAE LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3132
Mailing Address - Country:US
Mailing Address - Phone:318-509-9622
Mailing Address - Fax:
Practice Address - Street 1:1330 QUAIL LAKE LOOP STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-540-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist