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General NPI Number Information
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NPI Number | 1508810128
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Entity Type | Individual
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Provider Name | JENNIFER GRACE STEVENS M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1540 SPRING VALLEY DR
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City | HUNTINGTON
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State | WV
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Zip | 25704-9300
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Country | US
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Telephone | 304-429-6755
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Fax |
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Provider Business Mailing Address
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Address Line | 26 ELM ST
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City | WINFIELD
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State | WV
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Zip | 25213-9376
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Country | US
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Telephone | 304-586-2364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP-0427
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License Number State | WV
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