Provider Demographics
NPI:1770035537
Name:CETNAR, STEPHANIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CETNAR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HUBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:206 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4617
Mailing Address - Country:US
Mailing Address - Phone:813-662-1060
Mailing Address - Fax:813-662-0530
Practice Address - Street 1:206 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510
Practice Address - Country:US
Practice Address - Phone:813-662-1060
Practice Address - Fax:813-662-0530
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770035537OtherNPI