Provider Demographics
NPI:1255513818
Name:ADAMOVICH, STEPHANIE LEIGH (PHD, CCC-A)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:ADAMOVICH
Suffix:
Gender:F
Credentials:PHD, CCC-A
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEIGH
Other - Last Name:WIXOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4838 E BASELINE RD
Mailing Address - Street 2:STE 126
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4673
Mailing Address - Country:US
Mailing Address - Phone:480-965-2373
Mailing Address - Fax:480-965-0076
Practice Address - Street 1:ARIZONA STATE UNIVERSITY SPEECH AND
Practice Address - Street 2:975 S. MYRTLE AVE
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85287-0001
Practice Address - Country:US
Practice Address - Phone:480-965-2373
Practice Address - Fax:480-965-0076
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA7605231H00000X, 237600000X, 231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner