Provider Demographics
NPI:1073944864
Name:STEVENS, MANDY (MA, SLP)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-9712
Mailing Address - Country:US
Mailing Address - Phone:904-248-1167
Mailing Address - Fax:
Practice Address - Street 1:2050 PINE LOG RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5731
Practice Address - Country:US
Practice Address - Phone:803-641-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC250607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist