Provider Demographics
NPI:1750647202
Name:STEVENS, ROXANNE MARIKO (MA)
Entity type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:MARIKO
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 WESTWOOD DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5104
Mailing Address - Country:US
Mailing Address - Phone:408-641-7611
Mailing Address - Fax:
Practice Address - Street 1:1685 WESTWOOD DR STE 3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5104
Practice Address - Country:US
Practice Address - Phone:408-641-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19924235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist