Provider Demographics
NPI:1083950133
Name:PENDLEY, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 FOUNTAIN DR
Mailing Address - Street 2:STE D
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5324
Mailing Address - Country:US
Mailing Address - Phone:219-689-0008
Mailing Address - Fax:
Practice Address - Street 1:5201 FOUNTAIN DR
Practice Address - Street 2:STE D
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5324
Practice Address - Country:US
Practice Address - Phone:219-689-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant