Provider Demographics
NPI:1316185770
Name:STEFANACCI, RENEE REMY (MA-SLP, CCC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:REMY
Last Name:STEFANACCI
Suffix:
Gender:F
Credentials:MA-SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3039
Mailing Address - Country:US
Mailing Address - Phone:201-218-9167
Mailing Address - Fax:
Practice Address - Street 1:478 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-3039
Practice Address - Country:US
Practice Address - Phone:201-218-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00439400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist