Stacy Derenard, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP 14604 Issued in CA

Practice address

12060 Valley View St
Suite 137
Garden Grove, CA 92845

Phone

(714) 901-1518

Fax

(714) 901-1359

NPI assigned

May 22, 2007

Last updated

Mar 1, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Expressions Speech Language Pathology Services Inc

  • Speech-Language Pathologist
  • Garden Grove, CA
  • NPI 1689893075
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488326400000",
    "number": "1427267608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5241 BERKELEY AVE",
            "address_2": "APT. B",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926832739",
            "telephone_number": "714-901-1518",
            "fax_number": "714-901-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12060 VALLEY VIEW ST",
            "address_2": "SUITE 137",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "92845",
            "telephone_number": "714-901-1518",
            "fax_number": "714-901-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERENARD",
        "first_name": "STACY",
        "name_prefix": "Mrs.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2017-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP 14604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.