Provider Demographics
NPI:1346359452
Name:FLECK, STEPHANIE KRISTINE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:KRISTINE
Last Name:FLECK
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 KNECHTEL WAY NE STE 105
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2834
Mailing Address - Country:US
Mailing Address - Phone:206-842-6374
Mailing Address - Fax:
Practice Address - Street 1:345 KNECHTEL WAY NE STE 105
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2834
Practice Address - Country:US
Practice Address - Phone:206-842-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004084231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8868262Medicare PIN