Provider Demographics
NPI:1437471828
Name:STUBLEN, GRETA P (MS, CCC-SP)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:P
Last Name:STUBLEN
Suffix:
Gender:F
Credentials:MS, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30361 ALDER RD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-3329
Mailing Address - Country:US
Mailing Address - Phone:941-639-6631
Mailing Address - Fax:
Practice Address - Street 1:30361 ALDER RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-3329
Practice Address - Country:US
Practice Address - Phone:941-639-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist