Provider Demographics
NPI:1972654366
Name:SHAEFFER, STEPHANIE ROWE (MS CCC-SLP CERT AVT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ROWE
Last Name:SHAEFFER
Suffix:
Gender:F
Credentials:MS CCC-SLP CERT AVT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:SHAEFFER-TREVISAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP CERT AVT
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0087
Mailing Address - Country:US
Mailing Address - Phone:908-879-0404
Mailing Address - Fax:908-879-1474
Practice Address - Street 1:11 BURNETT DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2716
Practice Address - Country:US
Practice Address - Phone:908-879-0404
Practice Address - Fax:908-879-1474
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00199400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist