Provider Demographics
NPI:1780463372
Name:STETTER, GINA MARIE (SLP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:STETTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 STULTZ GAP RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-3234
Mailing Address - Country:US
Mailing Address - Phone:540-333-1980
Mailing Address - Fax:
Practice Address - Street 1:2580 STULTZ GAP RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-3234
Practice Address - Country:US
Practice Address - Phone:540-333-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist