Individual
STEPHANIE GRACE DISTELRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLPA
Contact information
Practice address
410 E MERCED AVE STE E, WEST COVINA, CA 91790-5058
(909) 331-7693
Mailing address
PO BOX 1817, UPLAND, CA 91785-1817
(909) 331-7693
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
1447
CA
Other
Enumeration date
06/05/2019
Last updated
06/05/2019
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