Provider Demographics
NPI:1447409032
Name:STEPHAN, LAURA (CCC SL/P)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:CCC SL/P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 MALVERN AVE
Mailing Address - Street 2:OVERBROOK SCHOOL FOR THE BLIND
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2529
Mailing Address - Country:US
Mailing Address - Phone:215-877-0313
Mailing Address - Fax:
Practice Address - Street 1:6333 MALVERN AVE
Practice Address - Street 2:OVERBROOK SCHOOL FOR THE BLIND
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2529
Practice Address - Country:US
Practice Address - Phone:215-877-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist