Provider Demographics
NPI:1417240169
Name:ZOCH, STEPHANIE E
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:ZOCH
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 1:310 PAPER TRAIL WAY
Mailing Address - Street 2:STE 302
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-5203
Mailing Address - Country:US
Mailing Address - Phone:770-345-2804
Mailing Address - Fax:678-827-0927
Practice Address - Street 1:310 PAPER TRAIL WAY
Practice Address - Street 2:STE 302
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-5203
Practice Address - Country:US
Practice Address - Phone:770-345-2804
Practice Address - Fax:678-827-0927
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist