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 1:22101 VENZKE RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9764
Mailing Address - Country:US
Mailing Address - Phone:916-918-5343
Mailing Address - Fax:
Practice Address - Street 1:140 DIAMOND CREEK PL STE 110
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6653
Practice Address - Country:US
Practice Address - Phone:916-918-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist