| Doctor Name: | MINDI STAVISH |
| NPI Number: | 1679726194 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | 2202005015 |
| Business Practice Address: | 10458 Sugarberry St Waldorf, MD - 206035732 |
| Business Phone Number: | 7036786556 |
| Business Fax Number: | |
| Mailing Address: | 10458 Sugarberry St, WALDORF |
| State: | MD |
| Postal Code: | 206035732 |
| Phone Number: | 3016380656 |
| Fax Number: | |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 05/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2202005015 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| 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 |