Provider Demographics
NPI:1740771674
Name:ALLISS, STEFANIE JEANE (SLPA)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:JEANE
Last Name:ALLISS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 ARAPAHO DR APT 101
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-5778
Mailing Address - Country:US
Mailing Address - Phone:928-566-5475
Mailing Address - Fax:
Practice Address - Street 1:3180 ARAPAHO DR APT 101
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-5778
Practice Address - Country:US
Practice Address - Phone:928-566-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA104382355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant