Provider Demographics
NPI:1043947310
Name:JAFFE, STEPHANIE ALYSSA CATHERINE (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ALYSSA CATHERINE
Last Name:JAFFE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 VETERANS PKWY APT 1612
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2490
Mailing Address - Country:US
Mailing Address - Phone:561-714-5425
Mailing Address - Fax:
Practice Address - Street 1:2816 WASHINGTON RD STE 106
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2194
Practice Address - Country:US
Practice Address - Phone:706-993-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004341231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist