Provider Demographics
NPI:1952563637
Name:STEVENS, CARISSA (SP/L)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:SP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 SORGHUM MILL RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-1935
Mailing Address - Country:US
Mailing Address - Phone:302-697-3103
Mailing Address - Fax:302-697-4998
Practice Address - Street 1:278 SORGHUM MILL RD
Practice Address - Street 2:
Practice Address - City:CAMDEN WYOMING
Practice Address - State:DE
Practice Address - Zip Code:19934-1935
Practice Address - Country:US
Practice Address - Phone:302-697-3103
Practice Address - Fax:302-697-4998
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0000255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist