Provider Demographics
NPI:1598911430
Name:DISNEY, STEPHANIE L (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:DISNEY
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 13TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1692
Mailing Address - Country:US
Mailing Address - Phone:304-522-8800
Mailing Address - Fax:304-523-4303
Practice Address - Street 1:1616 13TH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1692
Practice Address - Country:US
Practice Address - Phone:304-522-8800
Practice Address - Fax:304-523-4303
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0251231H00000X
KY0359237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013153Medicaid
KYP00644182Medicare PIN
WV3810013153Medicaid
WVDI4248131Medicare PIN
WVP00644177Medicare PIN