Individual
STACEY JUSTINE BERNAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
704 FORTINO BLVD, SUITE A, PUEBLO, CO 81008-2086
(719) 305-8313
Mailing address
704 FORTINO BLVD, SUITE A, PUEBLO, CO 81008-2086
(719) 305-8313
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0001282
CO
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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