Provider Demographics
NPI:1558841841
Name:STEFANAC, LORI BETH (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BETH
Last Name:STEFANAC
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 GLENWATER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8557
Mailing Address - Country:US
Mailing Address - Phone:704-549-0807
Mailing Address - Fax:
Practice Address - Street 1:9200 GLENWATER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8557
Practice Address - Country:US
Practice Address - Phone:704-549-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist