MEDICARE: MR. STEPHEN C. BABCOCK M.ED.

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	235500000X	Speech/Language/Hearing Specialist/Technologist	1170148	AZ

General Provider Information

NPI Number	:	1245379460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN C. BABCOCK M.ED.

Provider Business Mailing Address
First Line	:	13150 RED MOUNTAIN RD
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-8548
Country	:	US
Telephone Number	:	928-607-7614
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 LEUPP RD
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-8501
Country	:	US
Telephone Number	:	602-412-3533
Fax Number	:	928-225-2179

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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