Provider Demographics
NPI:1619300696
Name:STEVENSON, VANESSA KIMBERLY
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:KIMBERLY
Last Name:STEVENSON
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 1:45 N UNION AVE UNIT 578
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2574
Mailing Address - Country:US
Mailing Address - Phone:302-401-1121
Mailing Address - Fax:
Practice Address - Street 1:24 VETERANS SQ
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3155
Practice Address - Country:US
Practice Address - Phone:302-401-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist