Basic Information
| Provider Information | |||||||||
| NPI: | 1306820352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | VICTOR | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565433221 | ||||||||
| FaxNumber: | 2565439354 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565433221 | ||||||||
| FaxNumber: | 2565439354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 01/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 791A | AL | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 791A | AL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.