Basic Information
| Provider Information | |||||||||
| NPI: | 1518478924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEPHEN | ||||||||
| FirstName: | DENI | ||||||||
| MiddleName: | MATHEW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 769 CASCADING CREEK LN | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347875911 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 NW 4TH ST | ||||||||
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| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334323826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613918444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2017 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ8204 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.