Provider Demographics
NPI:1245379460
Name:BABCOCK, STEPHEN C (MED)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:C
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13150 RED MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-8548
Mailing Address - Country:US
Mailing Address - Phone:928-607-7614
Mailing Address - Fax:
Practice Address - Street 1:145 LEUPP RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-8501
Practice Address - Country:US
Practice Address - Phone:602-412-3533
Practice Address - Fax:928-225-2179
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1170148235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist