MEDICARE: MRS. STEPHANIE CHARNAM ONG 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	SA6982	FL

General Provider Information

NPI Number	:	1144378829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE CHARNAM ONG CCC-SLP

Provider Business Mailing Address
First Line	:	3824 W SAN PEDRO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7808
Country	:	US
Telephone Number	:	813-837-3445
Fax Number	:

Provider Business Practice Location Address
First Line	:	8019 N HIMES AVE STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2761
Country	:	US
Telephone Number	:	813-933-7300
Fax Number	:	813-933-3550

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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