Provider Demographics
NPI:1043366198
Name:STEVICK, ELAINE MARIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARIA
Last Name:STEVICK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1301 REDWOOD WAY
Mailing Address - Street 2:SUITE 165
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1107
Mailing Address - Country:US
Mailing Address - Phone:707-763-6419
Mailing Address - Fax:707-763-2537
Practice Address - Street 1:1301 REDWOOD WAY
Practice Address - Street 2:SUITE 165
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1107
Practice Address - Country:US
Practice Address - Phone:707-763-6419
Practice Address - Fax:707-763-2537
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP2710OtherSPEECH PATH LICENSE