MEDICARE: STEPHANIE ROMERO

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	4319	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	314219	OTHER	AZ	AHCCCS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598147233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ROMERO

Provider Business Mailing Address
First Line	:	2934 W MALDONADO RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6368
Country	:	US
Telephone Number	:	602-741-4912
Fax Number	:

Provider Business Practice Location Address
First Line	:	2934 W MALDONADO RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6368
Country	:	US
Telephone Number	:	602-741-4912
Fax Number	:

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

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	07/20/2015

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Directions to “ STEPHANIE ROMERO ” Practice Location

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