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General NPI Number Information
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NPI Number | 1861861460
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Entity Type | Individual
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Provider Name | STEPHANIE DESILET MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 07/21/2024
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Provider Practice Location Address
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Address Line | 850 INDIGO ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3763
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Country | US
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Telephone | 904-635-3179
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Fax | 904-372-0496
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Provider Business Mailing Address
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Address Line | 1463 NECTARINE ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3027
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Country | US
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Telephone | 904-491-6660
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Fax | 904-372-0496
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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 | SA13992
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License Number State | FL
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