Individual
SUSAN A STEPHENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
502 WHEAT AVE, BAINBRIDGE, GA 39819-4325
(229) 246-4088
(229) 246-0205
Mailing address
502 WHEAT AVE, BAINBRIDGE, GA 39819-4325
(229) 246-4088
(229) 246-0205
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PECT003772
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58-2082439
TAX ID
GA
Enumeration date
01/18/2023
Last updated
03/07/2024
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