Provider Demographics
NPI:1104227610
Name:STEVENSON, STEPHANIE DAWN
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:DAWN
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP, RDH
Mailing Address - Street 1:333 CINDY CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2344
Mailing Address - Country:US
Mailing Address - Phone:817-658-7539
Mailing Address - Fax:
Practice Address - Street 1:333 CINDY CT
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2344
Practice Address - Country:US
Practice Address - Phone:817-658-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13414124Q00000X
TX110426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No124Q00000XDental ProvidersDental Hygienist