Doctor Name: | MR. STEVEN LYNN WIDENHOUSE |
NPI Number: | 1205169604 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CCC-SLP |
License Number: | 2773 |
Business Practice Address: | 2601 Reynolda Rd Winston Salem, NC - 271063863 |
Business Phone Number: | 3367572349 |
Business Fax Number: | |
Mailing Address: | 2601 Reynolda Rd, WINSTON SALEM |
State: | NC |
Postal Code: | 271063863 |
Phone Number: | 3367572349 |
Fax Number: | |
NPI Enumeration Date: | 09/16/2009 |
NPI Last Update Date: | 02/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2773 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |