Provider Demographics
NPI:1811292782
Name:TZIAVARAS, STEPHANE ASIMACOPOULOS (CCC/SLP)
Entity type:Individual
Prefix:
First Name:STEPHANE
Middle Name:ASIMACOPOULOS
Last Name:TZIAVARAS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WYATT CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2710
Mailing Address - Country:US
Mailing Address - Phone:916-884-4369
Mailing Address - Fax:
Practice Address - Street 1:202 WYATT CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2710
Practice Address - Country:US
Practice Address - Phone:916-884-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist