Provider Demographics
NPI:1013221621
Name:POLLARD, STEPHANIE K (SP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:POLLARD
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 BREA BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4125
Mailing Address - Country:US
Mailing Address - Phone:714-394-9150
Mailing Address - Fax:714-671-7820
Practice Address - Street 1:1370 BREA BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4125
Practice Address - Country:US
Practice Address - Phone:714-394-9150
Practice Address - Fax:714-671-7820
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP7704235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist