MEDICARE: MRS. JANET M STAHL MS SLP CCC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202002906	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4980093	OTHER	VIRGINIA PREMIER HEALTH P
2	11230802	OTHER	CAQH
3	219567	OTHER	ANTHEM BLUE CROSS
4	35062	OTHER	OPTIMA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	7039322	OTHER	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	350034	OTHER	OPTIMA GROUP
9	64 00313	OTHER	UNITED HEALTH CARE
10	007328	OTHER	ANTHEM BLUE CROSS GROUP
11	5275769	OTHER	AETNA GROUP

NPI Number	:	1891776886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET M STAHL MS SLP CCC

Provider Business Mailing Address
First Line	:	818 NEWTOWN RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1116
Country	:	US
Telephone Number	:	757-473-8016
Fax Number	:	757-473-3580

Provider Business Practice Location Address
First Line	:	818 NEWTOWN RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1116
Country	:	US
Telephone Number	:	757-473-8016
Fax Number	:	757-473-3580

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/09/2007

802 NEWTOWN RD
VIRGINIA BEACH, VA
23462-1116

Practice Phone: 757-497-0606
Practice Fax: 757-497-0411

818 NEWTOWN RD
VIRGINIA BEACH, VA
23462-1116