Stephanie Revollo

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

1340 Braddock PL
Alexandria, VA 22314-1693

Phone

(703) 619-8139

NPI assigned

Oct 16, 2018

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Expressable Therapy of New Jersey PC

  • Speech-Language Pathologist
  • Roseland, NJ
  • NPI 1811615685
  NPD
• Expressable Therapy PC

  • Speech-Language Pathologist
  • Austin, TX
  • NPI 1134875370
  NPD
• Francis C Hammond

  • Preferred Provider Organization
  • Alexandria, VA
  • NPI 1396584074
  NPD (past)

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

{
    "created_epoch": "1539648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1770059966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 RICHARDSON AVE",
            "city": "HALEDON",
            "state": "NJ",
            "postal_code": "075081714",
            "telephone_number": "973-900-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BRADDOCK PL",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223141693",
            "telephone_number": "703-619-8139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVOLLO",
        "first_name": "STEPHANIE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-16",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Restoring Eden Counseling, LLC
• Lauren Retton
• Nidhi Reva, P.A.
• Virginia L Revere, PH.D.
• Revive Clinic LLC
• Stephen W Rex, MD
• Nicole Lynn Reybok
• Tiffany Rachel Reyes Perdomo
• Lisbeth Reyes-Hernandez
• Karen J. Reyes-Negron, LCSW

• Speech-Language Pathologist in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.