Provider Demographics
NPI:1518006915
Name:RANDALL, STEPHANIE MARIE (MS, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8435 BASUTO DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4584
Mailing Address - Country:US
Mailing Address - Phone:727-372-2678
Mailing Address - Fax:
Practice Address - Street 1:14100 FIVAY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7180
Practice Address - Country:US
Practice Address - Phone:727-869-9479
Practice Address - Fax:727-861-7135
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ3954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist