Provider Demographics
NPI:1598766909
Name:BARRY, STEPHANIE LAVON (MS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LAVON
Last Name:BARRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:LAVON
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4650 W BUCKSKIN TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-2316
Mailing Address - Country:US
Mailing Address - Phone:602-793-2958
Mailing Address - Fax:602-793-2958
Practice Address - Street 1:4650 W BUCKSKIN TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-2316
Practice Address - Country:US
Practice Address - Phone:602-793-2958
Practice Address - Fax:602-793-2958
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-01-11
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AZSLP4043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP4043OtherSTATE LICENSE