Provider Demographics
NPI:1083747059
Name:PEARL, STACIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:
Last Name:PEARL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1120
Mailing Address - Country:US
Mailing Address - Phone:914-301-5091
Mailing Address - Fax:914-428-8004
Practice Address - Street 1:141 S CENTRAL AVE
Practice Address - Street 2:SUITE #305
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2319
Practice Address - Country:US
Practice Address - Phone:914-428-8004
Practice Address - Fax:914-428-8003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011483-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist