Provider Demographics
NPI:1497853980
Name:FISH, STEPHANIE MCGOWAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MCGOWAN
Last Name:FISH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:750 WILLIAMSBURG CT NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2539
Mailing Address - Country:US
Mailing Address - Phone:704-239-6321
Mailing Address - Fax:844-708-0619
Practice Address - Street 1:140 CABARRUS AVE W
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5150
Practice Address - Country:US
Practice Address - Phone:704-239-6321
Practice Address - Fax:844-708-0619
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411555Medicaid
NC1831306471Medicaid