Provider Demographics
NPI:1275044364
Name:HYDE, STEPHANIE HAYDEN (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HAYDEN
Last Name:HYDE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:HANSON
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:149 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3564
Mailing Address - Country:US
Mailing Address - Phone:978-774-7570
Mailing Address - Fax:978-777-8547
Practice Address - Street 1:49 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-4087
Practice Address - Country:US
Practice Address - Phone:917-454-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MESP3406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist