Provider Demographics
NPI:1841431715
Name:STEPHENSON, JOE BRYANT (NBC-HIS)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:BRYANT
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S KERR AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1425
Mailing Address - Country:US
Mailing Address - Phone:910-452-4888
Mailing Address - Fax:910-452-5301
Practice Address - Street 1:118 S KERR AVE STE C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1425
Practice Address - Country:US
Practice Address - Phone:910-452-4888
Practice Address - Fax:910-452-5301
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC603237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist