Healthcare Provider Details

I. General information

NPI: 1114446887
Provider Name (Legal Business Name): STEPHANIE OWINGS MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 2ND AVE NE STE 900
ST PETERSBURG FL
33701-3434
US

IV. Provider business mailing address

PO BOX 518
CHATEAUGAY NY
12920-0518
US

V. Phone/Fax

Practice location:
  • Phone: 813-690-1327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: