Provider Demographics
NPI:1275072043
Name:STEPHENS, CARRIE ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:STEPHENS
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 1:120 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7502
Mailing Address - Country:US
Mailing Address - Phone:662-279-1938
Mailing Address - Fax:
Practice Address - Street 1:608 MCLARTY RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4500
Practice Address - Country:US
Practice Address - Phone:662-279-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS259473OtherMISSISSIPPI EDUCATOR LICENSE
MSS3889OtherSTATE LICENSE SPEECH LANGUAGE PATHOLOGY
MS14037137OtherAMERICAN SPEECH LANGUAGE AND HEARING ASSOCIATION