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General NPI Number Information
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NPI Number | 1801533211
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Entity Type | Individual
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Provider Name | STEPHANIE FUQUA MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 500 W LYNDALE AVE
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City | ROBINSON
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State | TX
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Zip | 76706-5505
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Country | US
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Telephone | 254-662-0194
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W LYNDALE AVE
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City | ROBINSON
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State | TX
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Zip | 76706-5505
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Country | US
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Telephone | 972-795-1315
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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 | 110245
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License Number State | TX
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