Provider Demographics
NPI:1083990998
Name:MCKINNEY, STEPHANIE PERKINS (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PERKINS
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1969 OLD GREENLEE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-8495
Mailing Address - Country:US
Mailing Address - Phone:828-559-1119
Mailing Address - Fax:828-800-9904
Practice Address - Street 1:1969 OLD GREENLEE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-8495
Practice Address - Country:US
Practice Address - Phone:828-559-1119
Practice Address - Fax:828-800-9904
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413770Medicaid