Provider Demographics
NPI:1437581402
Name:RENDON, STEPHANIE MICHELLE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:RENDON
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 1:6242 ORAM ST
Mailing Address - Street 2:APT F
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3910
Mailing Address - Country:US
Mailing Address - Phone:214-499-1562
Mailing Address - Fax:
Practice Address - Street 1:6242 ORAM ST
Practice Address - Street 2:APT F
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3910
Practice Address - Country:US
Practice Address - Phone:214-499-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367832355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant