Provider Demographics
NPI:1609547058
Name:STEWART-VAZQUEZ, SEANN (SLP)
Entity Type:Individual
Prefix:
First Name:SEANN
Middle Name:
Last Name:STEWART-VAZQUEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 SHRADER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4217
Mailing Address - Country:US
Mailing Address - Phone:415-519-8471
Mailing Address - Fax:
Practice Address - Street 1:1112 SHRADER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-4217
Practice Address - Country:US
Practice Address - Phone:415-519-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist