MEDICARE: DONNA SHULER STEVENS CCC-SLP, MSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	627	SC

General Provider Information

NPI Number	:	1053992842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA SHULER STEVENS CCC-SLP, MSP

Provider Business Mailing Address
First Line	:	196 BEECHWOOD DR
Second Line	:
City	:	PAULINE
State	:	SC
Zip	:	29374-2530
Country	:	US
Telephone Number	:	864-590-3489
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 BEECHWOOD DR
Second Line	:
City	:	PAULINE
State	:	SC
Zip	:	29374-2530
Country	:	US
Telephone Number	:	864-590-3489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	04/14/2021

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Directions to “ DONNA SHULER STEVENS CCC-SLP, MSP” Practice Location

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