MEDICARE: STEPHANIE MARIE VERDIN BALDERAS 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	105395	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922333046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE VERDIN BALDERAS MS CCC/SLP

Provider Business Mailing Address
First Line	:	305 NE LOOP 820
Second Line	:	BUSINESS TOWER 1 SUITE 200
City	:	HURST
State	:	TX
Zip	:	76053-7209
Country	:	US
Telephone Number	:	817-789-6849
Fax Number	:	817-789-6849

Provider Business Practice Location Address
First Line	:	709 ANGELITA DR
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78599-5281
Country	:	US
Telephone Number	:	956-854-4325
Fax Number	:	956-854-4338

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	01/09/2015

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