Provider Demographics
NPI:1114282480
Name:TOLLEY, STEPHANIE GERLICH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:GERLICH
Last Name:TOLLEY
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 1:905 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1650
Mailing Address - Country:US
Mailing Address - Phone:251-689-1662
Mailing Address - Fax:
Practice Address - Street 1:905 E. 36TH ST. CHARLOTTE, NC 28205
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2820
Practice Address - Country:US
Practice Address - Phone:251-689-1662
Practice Address - Fax:833-814-5516
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist