Provider Demographics
NPI:1659536886
Name:BRESNOCK, STEPHEN T JR (SLP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:BRESNOCK
Suffix:JR
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 HASTINGS LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2110
Mailing Address - Country:US
Mailing Address - Phone:540-347-4770
Mailing Address - Fax:
Practice Address - Street 1:2179 BROWN LN
Practice Address - Street 2:
Practice Address - City:AMISSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20106-2009
Practice Address - Country:US
Practice Address - Phone:540-937-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist