MEDICARE: STEPHANIE NICOLE KEFFER MS, 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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1104335835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE KEFFER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	2936 WORDEN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 WORDEN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5708
Country	:	US
Telephone Number	:	704-942-0041
Fax Number	:

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

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/28/2022

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