Provider Demographics
NPI:1740933985
Name:SCOLINOS, STEPHANIE DAVIS (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DAVIS
Last Name:SCOLINOS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 WADSWORTH LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3467
Mailing Address - Country:US
Mailing Address - Phone:562-299-7208
Mailing Address - Fax:
Practice Address - Street 1:1017 WADSWORTH LN
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3467
Practice Address - Country:US
Practice Address - Phone:562-299-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist