Provider Demographics
NPI:1508201278
Name:STOLCZ, AMANDA LAUREN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LAUREN
Last Name:STOLCZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 155TH AVE
Mailing Address - Street 2:APT. 5K
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2109
Mailing Address - Country:US
Mailing Address - Phone:917-846-2428
Mailing Address - Fax:
Practice Address - Street 1:4223 FRANCIS LEWIS BLVD
Practice Address - Street 2:LL107
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2575
Practice Address - Country:US
Practice Address - Phone:718-767-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist