Basic Information
| Provider Information | |||||||||
| NPI: | 1023384906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENSON | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | HERSTAM | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD | ||||||||
| Address2: | SUITE 200 ATTN: AMY GRAY | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405360234 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 SUNRISE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROMNEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 267574607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048224561 | ||||||||
| FaxNumber: | 3048227809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2012 | ||||||||
| LastUpdateDate: | 06/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP-1369 | WV | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.