Provider Demographics
NPI:1295567899
Name:GARTMAN, STEPHANIE ELLEN
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:GARTMAN
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 1:19858 COUNTY ROAD 319
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422-7738
Mailing Address - Country:US
Mailing Address - Phone:979-248-6601
Mailing Address - Fax:
Practice Address - Street 1:19858 COUNTY ROAD 319
Practice Address - Street 2:
Practice Address - City:BRAZORIA
Practice Address - State:TX
Practice Address - Zip Code:77422-7738
Practice Address - Country:US
Practice Address - Phone:979-248-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)