Provider Demographics
NPI:1164504718
Name:MENA, STEFANIE (MS,CCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:
Last Name:MENA
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 1:3329 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-1824
Mailing Address - Country:US
Mailing Address - Phone:254-722-4065
Mailing Address - Fax:
Practice Address - Street 1:2124 N 25TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3317
Practice Address - Country:US
Practice Address - Phone:254-235-2430
Practice Address - Fax:254-235-2434
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist