Provider Demographics
NPI:1275787806
Name:NIXON, STEPHANIE MICHELLE (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:NIXON
Suffix:
Gender:F
Credentials:PHD, 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:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20868-0046
Mailing Address - Country:US
Mailing Address - Phone:301-660-7323
Mailing Address - Fax:866-887-9555
Practice Address - Street 1:15313 DURANT ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4210
Practice Address - Country:US
Practice Address - Phone:301-660-7323
Practice Address - Fax:866-887-9555
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist