Provider Demographics
NPI:1487935334
Name:KROEKER, STEPHANIE J
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:KROEKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1751 W CITRACADO PKWY
Mailing Address - Street 2:#185
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4157
Mailing Address - Country:US
Mailing Address - Phone:760-224-6661
Mailing Address - Fax:951-296-1943
Practice Address - Street 1:41689 ENTERPRISE CIR N
Practice Address - Street 2:SUITE 118
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5630
Practice Address - Country:US
Practice Address - Phone:951-541-0615
Practice Address - Fax:951-296-1943
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA5302355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant