Provider Demographics
NPI:1225273899
Name:VARON, STACY LOREN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LOREN
Last Name:VARON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4672 DA VINCI ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2728
Mailing Address - Country:US
Mailing Address - Phone:858-229-3437
Mailing Address - Fax:
Practice Address - Street 1:4672 DA VINCI ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2728
Practice Address - Country:US
Practice Address - Phone:858-229-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist