Provider Demographics
NPI:1306182811
Name:MCDOUGLE, STEPHANIE MICHELE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:MCDOUGLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MICHELE
Other - Last Name:HOLGUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:SPEECH PATHOLOGY DEPARTMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2745
Mailing Address - Country:US
Mailing Address - Phone:505-272-2974
Mailing Address - Fax:505-272-4906
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:SPEECH PATHOLOGY DEPARTMENT
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-2974
Practice Address - Fax:505-272-4906
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP5443235Z00000X
NMC-5246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist