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NPI Code Detail

MEDICARE: GINA WOOD STEVENS M.ED, CCC,SLP

MEDICARE: GINA WOOD STEVENS M.ED, CCC,SLP
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
1235Z00000XSpeech-Language PathologistSP-1383NV

General Provider Information

NPI Number : 1073808341
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA WOOD STEVENS M.ED, CCC,SLP
Provider Business Mailing Address
First Line : 820 CANTERRA ST UNIT 1053
Second Line :
City : LAS VEGAS
State : NV
Zip : 89138-4592
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3030 S JONES BLVD STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-6793
Country : US
Telephone Number : 702-360-1137
Fax Number : 702-240-1729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2011
Last Update Date : 06/15/2011

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