Provider Demographics
NPI:1144795204
Name:DORTON, STEPHANIE HOYLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HOYLE
Last Name:DORTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 BRIDLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0446
Mailing Address - Country:US
Mailing Address - Phone:704-807-8813
Mailing Address - Fax:
Practice Address - Street 1:4646 BRIDLE RIDGE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0446
Practice Address - Country:US
Practice Address - Phone:704-807-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist