Provider Demographics
NPI:1780701318
Name:STEVENS, NANCY EILEEN (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:EILEEN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:EILEEN
Other - Last Name:MACKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3014 MEYERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15209-1112
Mailing Address - Country:US
Mailing Address - Phone:412-821-3234
Mailing Address - Fax:
Practice Address - Street 1:3023 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105
Practice Address - Country:US
Practice Address - Phone:724-656-8814
Practice Address - Fax:724-656-8815
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009591710003OtherMEDICAL ASSISTANCE