Provider Demographics
NPI:1598199465
Name:GREAR, STEPHANIE N (SLP)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:N
Last Name:GREAR
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 1:3063 HOWARD AVE
Mailing Address - Street 2:APT 205
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1642
Mailing Address - Country:US
Mailing Address - Phone:706-399-4192
Mailing Address - Fax:
Practice Address - Street 1:8703 HIGHWAY 17 BYP S
Practice Address - Street 2:SUITE I
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-7701
Practice Address - Country:US
Practice Address - Phone:843-457-1053
Practice Address - Fax:843-215-2910
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3792235Z00000X
SC5402SPIN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist