Provider Demographics
NPI:1174836142
Name:MENZER, STEPHANIE JEANNE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JEANNE
Last Name:MENZER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:JEANNE
Other - Last Name:MANCINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:12 ABBOT ROAD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:516-708-3609
Mailing Address - Fax:718-767-0086
Practice Address - Street 1:12 ABBOT ROAD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:516-708-3609
Practice Address - Fax:718-767-0086
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1249484235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist