| Doctor Name: | STEPHANIE BLACK |
| NPI Number: | 1659707990 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | SLP12069775 |
| Business Practice Address: | 100 Hamilton Pointe Dr 115 & 120 Byron, GA - 31008 |
| Business Phone Number: | 4785381436 |
| Business Fax Number: | 4784746601 |
| Mailing Address: | 100 Hamilton Pointe Dr, Suite 115 & 120 BYRON |
| State: | GA |
| Postal Code: | 31008 |
| Phone Number: | 4785381436 |
| Fax Number: | 4784746601 |
| NPI Enumeration Date: | 09/18/2013 |
| NPI Last Update Date: | 09/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235500000X |
| License Number: | SLP12069775 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |