Provider Demographics
NPI:1679769707
Name:HARTNELL, STEFANIE ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:ANN
Last Name:HARTNELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9061 BIKINI VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-8078
Mailing Address - Country:US
Mailing Address - Phone:928-667-5045
Mailing Address - Fax:
Practice Address - Street 1:1600 S KOFA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-6403
Practice Address - Country:US
Practice Address - Phone:928-669-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist