Provider Demographics
NPI:1023384906
Name:STEVENSON, CARRIE HERSTAM (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:HERSTAM
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD
Mailing Address - Street 2:SUITE 200 ATTN: AMY GRAY
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-0234
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:363 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-4607
Practice Address - Country:US
Practice Address - Phone:304-822-4561
Practice Address - Fax:304-822-7809
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist