Provider Demographics
NPI:1750145058
Name:BRILL, STEPHANIE JEANENE (MA, SLP-A)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEANENE
Last Name:BRILL
Suffix:
Gender:F
Credentials:MA, SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 FRISCO ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:MO
Mailing Address - Zip Code:64865-9266
Mailing Address - Country:US
Mailing Address - Phone:417-776-7961
Mailing Address - Fax:
Practice Address - Street 1:1815 SAINT EUGENE ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:MO
Practice Address - Zip Code:64865-9367
Practice Address - Country:US
Practice Address - Phone:417-499-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190375512355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant