Healthcare Provider Details

I. General information

NPI: 1831213396
Provider Name (Legal Business Name): SHARLENE MARIE STAGER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARLENE MARIE GOMES M.A,

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 E PASEO ENCINO
ORACLE AZ
85623-6056
US

IV. Provider business mailing address

1290 E PASEO ENCINO
ORACLE AZ
85623-6056
US

V. Phone/Fax

Practice location:
  • Phone: 520-896-9011
  • Fax: 520-896-2045
Mailing address:
  • Phone: 520-896-9011
  • Fax: 520-896-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP0158
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: