Healthcare Provider Details

I. General information

NPI: 1063129633
Provider Name (Legal Business Name): STEPHANIE MARIE ROQUE CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12485 SW 137TH AVE STE 301
MIAMI FL
33186-4219
US

IV. Provider business mailing address

12485 SW 137TH AVE STE 301
MIAMI FL
33186-4219
US

V. Phone/Fax

Practice location:
  • Phone: 786-732-4922
  • Fax:
Mailing address:
  • Phone: 305-505-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: