Provider Demographics
NPI:1255359204
Name:KEMPER, STEPHANIE D (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:KEMPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-9253
Mailing Address - Country:US
Mailing Address - Phone:704-575-9289
Mailing Address - Fax:704-821-4831
Practice Address - Street 1:2329 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-9253
Practice Address - Country:US
Practice Address - Phone:704-575-9289
Practice Address - Fax:704-821-4831
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000815Medicaid