Provider Demographics
NPI:1003463423
Name:SHICKSNIDER, STEPHANIE VU
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VU
Last Name:SHICKSNIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-3644
Mailing Address - Country:US
Mailing Address - Phone:337-256-1419
Mailing Address - Fax:
Practice Address - Street 1:138 W 116TH ST
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-3644
Practice Address - Country:US
Practice Address - Phone:337-256-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
LA7659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist