Provider Demographics
NPI:1013478387
Name:WAITTE, STEFANI
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:WAITTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-3637
Mailing Address - Country:US
Mailing Address - Phone:610-363-1129
Mailing Address - Fax:
Practice Address - Street 1:223 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:CHESTER SPRGS
Practice Address - State:PA
Practice Address - Zip Code:19425-3637
Practice Address - Country:US
Practice Address - Phone:610-363-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist