Provider Demographics
NPI:1912112145
Name:DEGLAU, STEPHANIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:DEGLAU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 BROOKTREE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9287
Mailing Address - Country:US
Mailing Address - Phone:724-934-3905
Mailing Address - Fax:724-934-3906
Practice Address - Street 1:8500 BROOKTREE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9287
Practice Address - Country:US
Practice Address - Phone:724-934-3905
Practice Address - Fax:724-934-3906
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA331803OtherTRICARE