MEDICARE: MRS. STACEY ELIZABETH BROCK BERNASCONI 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	2202005383	VA

General Provider Information

NPI Number	:	1518468008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACEY ELIZABETH BROCK BERNASCONI MS CCC-SLP

Provider Business Mailing Address
First Line	:	8100 GUINEVERE DR
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-1300
Country	:	US
Telephone Number	:	703-645-7000
Fax Number	:	703-645-7097

Provider Business Practice Location Address
First Line	:	8100 GUINEVERE DR
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-1300
Country	:	US
Telephone Number	:	703-645-7000
Fax Number	:	703-645-7097

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

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	03/19/2026

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