MEDICARE: STEVIE LYNN BRUMWELL

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	SLP14688	AZ

General Provider Information

NPI Number	:	1639928021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVIE LYNN BRUMWELL

Provider Business Mailing Address
First Line	:	2268 S OSBORN LN
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-0012
Country	:	US
Telephone Number	:	661-992-6530
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 N SAN BENITO DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2490
Country	:	US
Telephone Number	:	480-900-3051
Fax Number	:

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

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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Directions to “ STEVIE LYNN BRUMWELL ” Practice Location

Language	Start Address	Practice Location

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