Provider Demographics
NPI:1568064210
Name:WALTON, STEPHANIE ROBIN (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROBIN
Last Name:WALTON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4378
Mailing Address - Country:US
Mailing Address - Phone:732-737-7071
Mailing Address - Fax:
Practice Address - Street 1:1026 BROAD ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4378
Practice Address - Country:US
Practice Address - Phone:732-737-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00731000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist