Provider Demographics
NPI:1225476674
Name:SOALT, STEPHANIE (ND)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SOALT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4548
Mailing Address - Country:US
Mailing Address - Phone:860-659-3553
Mailing Address - Fax:860-659-0744
Practice Address - Street 1:155 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4548
Practice Address - Country:US
Practice Address - Phone:860-659-3553
Practice Address - Fax:860-659-0744
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000499175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath