Provider Demographics
NPI:1598931743
Name:POWELL, STACY NICOLINI (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:NICOLINI
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HIDDEN TRL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9684
Mailing Address - Country:US
Mailing Address - Phone:716-629-3423
Mailing Address - Fax:716-629-3499
Practice Address - Street 1:4 HIDDEN TRL
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-9684
Practice Address - Country:US
Practice Address - Phone:716-629-3423
Practice Address - Fax:716-629-3499
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist