Doctor Name: | STEPHANIE DISILET |
NPI Number: | 1861861460 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | SA13992 |
Business Practice Address: | 1595 Linkside Dr Atlantic Beach, FL - 322337308 |
Business Phone Number: | 9046353179 |
Business Fax Number: | 9043720496 |
Mailing Address: | 1463 Nectarine St, FERNANDINA BEACH |
State: | FL |
Postal Code: | 320343027 |
Phone Number: | 9044916660 |
Fax Number: | 9043720496 |
NPI Enumeration Date: | 09/24/2015 |
NPI Last Update Date: | 09/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA13992 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
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 |