Provider Demographics
NPI:1043998529
Name:GARO, STEPHANIE L (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:GARO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DIAMOND CREEK PL STE 120
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5197
Mailing Address - Country:US
Mailing Address - Phone:916-755-4414
Mailing Address - Fax:916-755-4364
Practice Address - Street 1:130 DIAMOND CREEK PL STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5197
Practice Address - Country:US
Practice Address - Phone:916-755-4414
Practice Address - Fax:916-755-4364
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist