Provider Demographics
NPI:1346567070
Name:ECKERT, STEFANIE ANDERSON (MM, MT-BC)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ANDERSON
Last Name:ECKERT
Suffix:
Gender:F
Credentials:MM, MT-BC
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 230
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-0230
Mailing Address - Country:US
Mailing Address - Phone:210-392-1277
Mailing Address - Fax:
Practice Address - Street 1:20770 N HWY 281 STE 108-188
Practice Address - Street 2:STE 108-188
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7519
Practice Address - Country:US
Practice Address - Phone:210-392-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14422225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist