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NPI Code Detail

MEDICARE: STEPHANIE LYNN PHAM MS CCC-SLP

MEDICARE: STEPHANIE LYNN PHAM 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
1235Z00000XSpeech-Language Pathologist12011612

General Provider Information

NPI Number : 1336451236
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE LYNN PHAM MS CCC-SLP
Provider Business Mailing Address
First Line : 133 MOSSWOOD DR
Second Line :
City : PAGOSA SPRINGS
State : CO
Zip : 81147-8418
Country : US
Telephone Number : 970-731-3610
Fax Number :
Provider Business Practice Location Address
First Line : 701 CAMINO DEL RIO SUITE 221
Second Line :
City : PAGOSA SPRINGS
State : CO
Zip : 81147-9388
Country : US
Telephone Number : 970-247-3261
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2010
Last Update Date : 03/01/2023

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