Healthcare Provider Details

I. General information

NPI: 1588425441
Provider Name (Legal Business Name): MS. STEPHANIE LUCILLE TARGONSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S MILITARY TRL STE D
WEST PALM BEACH FL
33415-4698
US

IV. Provider business mailing address

224 SE SAINT LUCIE BLVD APT 206
STUART FL
34996-1387
US

V. Phone/Fax

Practice location:
  • Phone: 561-328-8312
  • Fax:
Mailing address:
  • Phone: 203-604-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8467
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: