Provider Demographics
NPI:1669110771
Name:CAREY, STEPHANIE HELEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HELEN
Last Name:CAREY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 WILD SENNA WAY
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-1825
Mailing Address - Country:US
Mailing Address - Phone:410-980-0642
Mailing Address - Fax:
Practice Address - Street 1:1192 WILD SENNA WAY
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-1825
Practice Address - Country:US
Practice Address - Phone:410-980-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX659249401Medicaid