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NPI Code Detail

MEDICARE: STEPHANIE R ANDERSON MC CCC-A

MEDICARE: STEPHANIE R ANDERSON MC CCC-A
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
1231H00000XAudiologist

General Provider Information

NPI Number : 1427106434
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE R ANDERSON MC CCC-A
Provider Business Mailing Address
First Line : 2944 BRECKENRIDGE LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40220-1409
Country : US
Telephone Number : 502-893-0159
Fax Number :
Provider Business Practice Location Address
First Line : 2944 BRECKENRIDGE LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40220-1409
Country : US
Telephone Number : 502-893-0159
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 11/15/2022

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