| Doctor Name: | MRS. STACY DERENARD |
| NPI Number: | 1427267608 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., CCC-SLP |
| License Number: | SP 14604 |
| Business Practice Address: | 12060 Valley View St Suite 137 Garden Grove, CA - 92845 |
| Business Phone Number: | 7149011518 |
| Business Fax Number: | 7149011359 |
| Mailing Address: | 16691 Bolsa Chica St, Apt. B HUNTINGTON BEACH |
| State: | CA |
| Postal Code: | 926493589 |
| Phone Number: | 7143772120 |
| Fax Number: | |
| NPI Enumeration Date: | 05/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP 14604 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |