MEDICARE: ROXANA STUBBEMANN

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	114151	TX

General Provider Information

NPI Number	:	1962902676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANA STUBBEMANN

Provider Business Mailing Address
First Line	:	11365 E RANCH CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-3217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7304 GOOD SAMARITAN CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1602
Country	:	US
Telephone Number	:	915-541-4683
Fax Number	:

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

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	02/19/2018

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Directions to “ ROXANA STUBBEMANN ” Practice Location

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