Provider Demographics
NPI:1073768263
Name:REBECCA J. KELLEY DBA THE STEPPINGSTONE AGENCY
Entity Type:Organization
Organization Name:REBECCA J. KELLEY DBA THE STEPPINGSTONE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:585-335-3953
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-0631
Mailing Address - Country:US
Mailing Address - Phone:585-335-3953
Mailing Address - Fax:585-335-3953
Practice Address - Street 1:5964 SHAFER RD
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9633
Practice Address - Country:US
Practice Address - Phone:585-335-3953
Practice Address - Fax:585-335-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009885-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency