Provider Demographics
NPI:1003180795
Name:ANTHONY, STEPHANIE KATHLEEN (MED)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KATHLEEN
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:KATHLEEN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:1 WHITMAN RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2707
Mailing Address - Country:US
Mailing Address - Phone:781-821-3499
Mailing Address - Fax:781-821-3905
Practice Address - Street 1:1 WHITMAN RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2707
Practice Address - Country:US
Practice Address - Phone:781-821-3499
Practice Address - Fax:781-821-3905
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1721302235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist