Provider Demographics
NPI:1881319234
Name:ALLEN, STEPHANIE JO
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-8142
Mailing Address - Country:US
Mailing Address - Phone:469-450-6787
Mailing Address - Fax:469-593-7411
Practice Address - Street 1:3301 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-8142
Practice Address - Country:US
Practice Address - Phone:469-450-6787
Practice Address - Fax:469-593-7411
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist