MEDICARE: VIVIANA M RODRIGUEZ STEWART 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	2092	PR
2	235Z00000X	Speech-Language Pathologist	108273	TX

General Provider Information

NPI Number	:	1891134300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANA M RODRIGUEZ STEWART MS, CCC-SLP

Provider Business Mailing Address
First Line	:	4755 GRAMERCY OAKS DR APT 119
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-5337
Country	:	US
Telephone Number	:	787-385-5517
Fax Number	:

Provider Business Practice Location Address
First Line	:	4825 ALLIANCE BLVD STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5504
Country	:	US
Telephone Number	:	787-385-5517
Fax Number	:	469-606-1383

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

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	05/18/2021

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Directions to “ VIVIANA M RODRIGUEZ STEWART MS, CCC-SLP” Practice Location

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