MEDICARE: STEFANIE BERNAL

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	101215	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101215	OTHER	TX	SLP LICENSE

General Provider Information

NPI Number	:	1548410335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE BERNAL

Provider Business Mailing Address
First Line	:	5504 LEGACY OAKS PKWY
Second Line	:
City	:	SCHERTZ
State	:	TX
Zip	:	78154-1192
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5504 LEGACY OAKS PKWY
Second Line	:
City	:	SCHERTZ
State	:	TX
Zip	:	78154-1192
Country	:	US
Telephone Number	:	210-363-9751
Fax Number	:

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

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	09/29/2008

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Directions to “ STEFANIE BERNAL ” Practice Location

Language	Start Address	Practice Location

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