Individual
MRS. STEPHANIE JO DETHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11523 VALLEY FRG, SELLERSBURG, IN 47172-8403
(502) 931-7111
(866) 528-4353
Mailing address
11523 VALLEY FRG, SELLERSBURG, IN 47172-8403
(502) 931-7111
(866) 528-4353
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
958866
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200825930
FIRST STEPS PROVIDER NUMB
IN
01
—
958866
TEACHER'S LICENSE
IN
Enumeration date
03/02/2007
Last updated
08/02/2024
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