Provider Demographics
NPI:1720219983
Name:THORNE, STEPHANIE LAUREN (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:THORNE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LAUREN
Other - Last Name:HOTALING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5945 FLETCHER RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-2931
Mailing Address - Country:US
Mailing Address - Phone:804-695-6293
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-4011
Practice Address - Country:US
Practice Address - Phone:757-846-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist