Provider Demographics
NPI:1083677082
Name:CLINGER, STEPHANIE ANN (MS, ATC, CSCS)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:CLINGER
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VARONE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7897
Mailing Address - Country:US
Mailing Address - Phone:860-287-9418
Mailing Address - Fax:
Practice Address - Street 1:616 GARRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3707
Practice Address - Country:US
Practice Address - Phone:860-287-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260018592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART00448OtherPENNSYLVANIA LICENSE
CT06-6000798OtherATHLETIC TRAINER
NY5435719UPDOtherNEW YORK LICENSE
VA0126001859OtherVIRGINIA STATE LICENSE