Provider Demographics
NPI:1174889240
Name:GARRITY, STEFANIE MICHELLE (MS-CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:MICHELLE
Last Name:GARRITY
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 MATTIE KELLY BLVD
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2811
Mailing Address - Country:US
Mailing Address - Phone:850-654-4588
Mailing Address - Fax:
Practice Address - Street 1:195 MATTIE KELLY BLVD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2811
Practice Address - Country:US
Practice Address - Phone:850-654-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist