MEDICARE: STEPHANIE BERARD CERTIFIED HAIR LOSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management
2	1744P3200X	Prosthetics Case Management	L784140626	LA

General Provider Information

NPI Number	:	1245693118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BERARD CERTIFIED HAIR LOSS

Provider Business Mailing Address
First Line	:	6606 EASTWOOD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-4244
Country	:	US
Telephone Number	:	832-292-9120
Fax Number	:

Provider Business Practice Location Address
First Line	:	6606 EASTWOOD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-4244
Country	:	US
Telephone Number	:	832-292-9120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	09/20/2018

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