Provider Demographics
NPI:1689190795
Name:STEPHENSON, TENECIA KEONNA
Entity Type:Individual
Prefix:
First Name:TENECIA
Middle Name:KEONNA
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17524 NW 61ST CT N
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4546
Mailing Address - Country:US
Mailing Address - Phone:786-859-5355
Mailing Address - Fax:
Practice Address - Street 1:5000 NW 182ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2923
Practice Address - Country:US
Practice Address - Phone:786-859-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist