Provider Demographics
NPI:1356463202
Name:STAHL, WENDY B
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:B
Last Name:STAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 TWO NOTCH RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4304
Mailing Address - Country:US
Mailing Address - Phone:803-736-5540
Mailing Address - Fax:803-699-0951
Practice Address - Street 1:9600 TWO NOTCH RD
Practice Address - Street 2:SUITE 24
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4304
Practice Address - Country:US
Practice Address - Phone:803-736-5540
Practice Address - Fax:803-699-0951
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC432OtherSTATE LICENSE