Provider Demographics
NPI:1164771382
Name:FAYANT, STEPHANIE ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:FAYANT
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 1:800 EASTMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4458
Mailing Address - Country:US
Mailing Address - Phone:509-884-7169
Mailing Address - Fax:509-884-4210
Practice Address - Street 1:800 EASTMONT AVE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4458
Practice Address - Country:US
Practice Address - Phone:509-884-7169
Practice Address - Fax:509-884-4210
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60384093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist