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NPI Code Detail

MEDICARE: CARISSA STEVENS SP/L

MEDICARE:   CARISSA  STEVENS  SP/L
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
1235Z00000XSpeech-Language PathologistO4-0000255DE

General Provider Information

NPI Number : 1952563637
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA STEVENS SP/L
Provider Business Mailing Address
First Line : 278 SORGHUM MILL RD
Second Line :
City : CAMDEN WYOMING
State : DE
Zip : 19934-1935
Country : US
Telephone Number : 302-697-3103
Fax Number : 302-697-4998
Provider Business Practice Location Address
First Line : 278 SORGHUM MILL RD
Second Line :
City : CAMDEN WYOMING
State : DE
Zip : 19934-1935
Country : US
Telephone Number : 302-697-3103
Fax Number : 302-697-4998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2008
Last Update Date : 06/25/2008

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Directions to “ CARISSA STEVENS SP/L” Practice Location

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