Provider Demographics
NPI:1336389972
Name:REYNOLDS, STEPHANIE R (SLP-CCC/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:SLP-CCC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 JOHN STREET
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:509-667-9061
Mailing Address - Fax:
Practice Address - Street 1:1410 JOHN ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6212
Practice Address - Country:US
Practice Address - Phone:509-667-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00003741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist