MEDICARE: MRS. KRISTIN ELIZABETH STEVENS 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	100124	TX

General Provider Information

NPI Number	:	1811034333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN ELIZABETH STEVENS MS,CCC-SLP

Provider Business Mailing Address
First Line	:	1835 PARADISE RIDGE DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5628
Country	:	US
Telephone Number	:	512-699-4216
Fax Number	:	512-331-9199

Provider Business Practice Location Address
First Line	:	1835 PARADISE RIDGE DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5628
Country	:	US
Telephone Number	:	512-699-4216
Fax Number	:	512-331-9199

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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