Provider Demographics
NPI:1902571219
Name:SIGMON, STEPHANIE BLAKE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:BLAKE
Last Name:SIGMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:BLAKE
Other - Last Name:MISCIAGNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 RUSSET LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-8517
Mailing Address - Country:US
Mailing Address - Phone:919-815-8751
Mailing Address - Fax:
Practice Address - Street 1:9621 BITTER MELON DR
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5917
Practice Address - Country:US
Practice Address - Phone:919-275-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14242448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist