Provider Demographics
NPI:1114647062
Name:ZUBER, STEFANIE REGINA
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:REGINA
Last Name:ZUBER
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 1:3391 STEEPLE WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5476
Mailing Address - Country:US
Mailing Address - Phone:404-964-7966
Mailing Address - Fax:
Practice Address - Street 1:3391 STEEPLE WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5476
Practice Address - Country:US
Practice Address - Phone:404-964-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA87-4145253OtherIRS