Provider Demographics
NPI:1437331519
Name:SADA, STEPHANIE L (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:SADA
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 NATIONAL RD
Mailing Address - Street 2:OHIO COUNTY BOARD OF EDUCATION
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5203
Mailing Address - Country:US
Mailing Address - Phone:304-243-0300
Mailing Address - Fax:304-243-0328
Practice Address - Street 1:2203 NATIONAL RD
Practice Address - Street 2:OHIO COUNTY BOARD OF EDUCATION
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5203
Practice Address - Country:US
Practice Address - Phone:304-243-0300
Practice Address - Fax:304-243-0328
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP-1104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004593Medicaid