Provider Demographics
NPI:1184097602
Name:ALVARADO GALLARDO, STEPHANEY
Entity type:Individual
Prefix:
First Name:STEPHANEY
Middle Name:
Last Name:ALVARADO GALLARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-1022
Mailing Address - Country:US
Mailing Address - Phone:520-661-8376
Mailing Address - Fax:
Practice Address - Street 1:10105 S SASABE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85736-1226
Practice Address - Country:US
Practice Address - Phone:520-822-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA822355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA82OtherARIZONA DEPARTMENT OF HEALTH SERVICES