Provider Demographics
NPI:1477826865
Name:STROM, STEPHANIE LEIGH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:STROM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEIGH
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20165 N 67TH AVE STE 122A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7155
Mailing Address - Country:US
Mailing Address - Phone:602-920-1209
Mailing Address - Fax:623-321-1177
Practice Address - Street 1:5775 GIRL RANCH RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:602-920-1209
Practice Address - Fax:623-321-1177
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ680678Medicaid