Provider Demographics
NPI:1396210175
Name:CRAIG, STEPHANIE MARY
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARY
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARY
Other - Last Name:POLIDORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1759 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1917
Mailing Address - Country:US
Mailing Address - Phone:248-798-5180
Mailing Address - Fax:
Practice Address - Street 1:800 W LONG LAKE RD
Practice Address - Street 2:SUITE 195
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-3405
Practice Address - Country:US
Practice Address - Phone:248-214-7755
Practice Address - Fax:248-855-4468
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI71010002172235Z00000X
MI7101002172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist