Provider Demographics
NPI:1467743237
Name:BERNDT, STEPHANIE (SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BERNDT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:538 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18690-0001
Mailing Address - Country:US
Mailing Address - Phone:419-889-0599
Mailing Address - Fax:419-889-0599
Practice Address - Street 1:220 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1137
Practice Address - Country:US
Practice Address - Phone:570-824-3444
Practice Address - Fax:570-824-4021
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394508OtherMEDICARE