Healthcare Provider Details

I. General information

NPI: 1750295861
Provider Name (Legal Business Name): STEPHANIE FETTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE PIKE

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 CHAPEL HILL BLVD
PLANO TX
75093-6392
US

IV. Provider business mailing address

2525 WINTERSTONE DR
PLANO TX
75023-7820
US

V. Phone/Fax

Practice location:
  • Phone: 469-777-4688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112494
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: