Provider Demographics
NPI:1821640277
Name:STEFFAN, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:STEFFAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 BRIERHEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2328
Mailing Address - Country:US
Mailing Address - Phone:901-288-6036
Mailing Address - Fax:
Practice Address - Street 1:5930 BRIERHEDGE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2328
Practice Address - Country:US
Practice Address - Phone:901-288-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist