Provider Demographics
NPI:1295215846
Name:CRONIN, STEPHANIE (SLP-CF)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CRONIN
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 E STATE HIGHWAY 174
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1115
Mailing Address - Country:US
Mailing Address - Phone:417-732-3630
Mailing Address - Fax:
Practice Address - Street 1:201 E STATE HIGHWAY 174
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1115
Practice Address - Country:US
Practice Address - Phone:417-732-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist