Provider Demographics
NPI:1043449564
Name:BLACKWELL, STEFANIE LEIGH (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:LEIGH
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16971 LAURELIN CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3814
Mailing Address - Country:US
Mailing Address - Phone:308-293-7048
Mailing Address - Fax:
Practice Address - Street 1:16971 LAURELIN CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3814
Practice Address - Country:US
Practice Address - Phone:308-293-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist