Provider Demographics
NPI:1992934798
Name:GOGLIA, STEPHANIE EILEEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EILEEN
Last Name:GOGLIA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12325 LOFT LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6634
Mailing Address - Country:US
Mailing Address - Phone:301-792-4766
Mailing Address - Fax:
Practice Address - Street 1:12325 LOFT LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6634
Practice Address - Country:US
Practice Address - Phone:301-792-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04403235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist