Basic Information
| Provider Information | |||||||||
| NPI: | 1073022315 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STEHOUWER | ||||||||
| FirstName: | TRAVIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 OLD CHAIN BRIDGE RD STE 185 | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221013945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039428110 | ||||||||
| FaxNumber: | 7039428042 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N WASHINGTON ST STE 102A | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220463441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032372716 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2017 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 01437 | MD | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | VA | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 2201001681 | VA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.