Provider Demographics
NPI:1578847885
Name:DRAKE, STEPHANIE ANNE (CCC-SLP, L-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANNE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:CCC-SLP, L-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DAYSPRING DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568
Mailing Address - Country:US
Mailing Address - Phone:315-986-3521
Mailing Address - Fax:
Practice Address - Street 1:1500 DAYSPRING DRIVE
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:NY
Practice Address - Zip Code:14568
Practice Address - Country:US
Practice Address - Phone:315-986-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0063581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist