MEDICARE: STEPHANIE ZEPEDA-LEDEZMA LCSW

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	1041C0700X	Clinical Social Worker	116315	CA

General Provider Information

NPI Number	:	1194575589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ZEPEDA-LEDEZMA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 18004
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96151-8004
Country	:	US
Telephone Number	:	530-318-6985
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 18004
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96151-8004
Country	:	US
Telephone Number	:	530-318-6985
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	05/07/2025

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