Provider Demographics
NPI:1174393615
Name:BINGHAM, STEPHANIE MICHELLE (SLPA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 SPOKANE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:MO
Mailing Address - Zip Code:65754-9118
Mailing Address - Country:US
Mailing Address - Phone:417-319-8160
Mailing Address - Fax:
Practice Address - Street 1:1123 SPOKANE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:MO
Practice Address - Zip Code:65754
Practice Address - Country:US
Practice Address - Phone:417-443-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230376202355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant