Healthcare Provider Details

I. General information

NPI: 1982907101
Provider Name (Legal Business Name): STEPHANIE MICHELLE CHESSER MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3978 ROYAL PINES DR
ORANGE PARK FL
32065-2553
US

IV. Provider business mailing address

3978 ROYAL PINES DR
ORANGE PARK FL
32065-2553
US

V. Phone/Fax

Practice location:
  • Phone: 904-291-7915
  • Fax:
Mailing address:
  • Phone: 904-291-7915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA10647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: