Provider Demographics
NPI:1124566815
Name:SCHULTHEISZ, STEPHANIE (CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:SCHULTHEISZ
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1931
Mailing Address - Country:US
Mailing Address - Phone:717-695-1488
Mailing Address - Fax:
Practice Address - Street 1:58 E CENTER ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543
Practice Address - Country:US
Practice Address - Phone:717-695-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011858235Z00000X
MI7101005152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist