MEDICARE: STEPHANIE SLALI

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	237600000X	Audiologist-Hearing Aid Fitter	AU2612	CA

General Provider Information

NPI Number	:	1851544381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SLALI

Provider Business Mailing Address
First Line	:	5000 CHESHIRE PKWY N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-4103
Country	:	US
Telephone Number	:	763-268-4317
Fax Number	:	763-268-4430

Provider Business Practice Location Address
First Line	:	801 ORANGE AVE
Second Line	:	SUITE 205
City	:	CORONADO
State	:	CA
Zip	:	92118-2663
Country	:	US
Telephone Number	:	619-437-8154
Fax Number	:	619-437-8328

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	08/03/2011

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Directions to “ STEPHANIE SLALI ” Practice Location

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