Provider Demographics
NPI:1326774704
Name:LOMAZOV, STEPHANIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LOMAZOV
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 1:5969 CATTLERIDGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6050
Mailing Address - Country:US
Mailing Address - Phone:941-263-8240
Mailing Address - Fax:941-907-8543
Practice Address - Street 1:5969 CATTLERIDGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6050
Practice Address - Country:US
Practice Address - Phone:941-263-8240
Practice Address - Fax:941-907-8543
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA19257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist