MEDICARE: STEPHANIE MARIE PEREZ-SELF M.S. 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	107262	TX

General Provider Information

NPI Number	:	1629351028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE PEREZ-SELF M.S. SLP

Provider Business Mailing Address
First Line	:	502 BEACONS HOLLOW LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2396
Country	:	US
Telephone Number	:	713-582-2349
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 BEACONS HOLLOW LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2396
Country	:	US
Telephone Number	:	281-724-0929
Fax Number	:

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

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	08/27/2015

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