Individual
FAYE BOLDWYN-STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
208 ZACHERY DR, MOUNT VERNON, IL 62864-6712
(618) 204-5497
Mailing address
11123 E IDLEWOOD RD, MOUNT VERNON, IL 62864-7678
(618) 244-6208
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
IL
Other
Enumeration date
06/20/2007
Last updated
07/08/2007
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