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Individual

CARSON STEPHENS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1851 GOLDEN EAGLE WAY STE 43, FLEMING ISLAND, FL 32003-4334
(904) 374-1414
Mailing address
2104 WHITE WING DOVE PL, SAINT JOHNS, FL 32259-2920
(904) 439-0003

Taxonomy

Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SI3626
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
SI3626
SPEECH LANGUAGE PATHOLOGIST ASSISTANT LICENSURE
FL
Enumeration date
04/11/2019
Last updated
11/27/2023
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