Provider Demographics
NPI:1902999543
Name:STEPHENS, CAROLINE (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MCGREGOR STREET
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-879-0830
Mailing Address - Fax:
Practice Address - Street 1:790 COLLEGE PARKWAY
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-847-3970
Practice Address - Fax:802-847-5880
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011496Medicaid
VTST 044564Medicare ID - Type UnspecifiedMEDICARE PART B