MEDICARE: STEPHANIE STEPHENSON

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	2355S0801X	Speech-Language Assistant	SLPA7636	AZ

General Provider Information

NPI Number	:	1740554591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE STEPHENSON

Provider Business Mailing Address
First Line	:	451 N SAN JOSE CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-4450
Country	:	US
Telephone Number	:	301-748-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 E WARNER RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-1057
Country	:	US
Telephone Number	:	480-963-5800
Fax Number	:

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

Provider Enumeration Date	:	02/25/2012
Last Update Date	:	02/25/2012

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Directions to “ STEPHANIE STEPHENSON ” Practice Location

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