MEDICARE: STEPHANIE FLOM

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	235Z00000X	Speech-Language Pathologist	5132	SC
2	235Z00000X	Speech-Language Pathologist	4594-154	WI
3	235Z00000X	Speech-Language Pathologist	501342	MN

General Provider Information

NPI Number	:	1255754586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE FLOM

Provider Business Mailing Address
First Line	:	3376 JUDD TRL
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-7602
Country	:	US
Telephone Number	:	847-528-5038
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 11TH ST W
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-3717
Country	:	US
Telephone Number	:	651-480-7000
Fax Number	:

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

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	10/02/2018

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Directions to “ STEPHANIE FLOM ” Practice Location

Language	Start Address	Practice Location

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