Provider Demographics
NPI:1669626412
Name:STEPHENS, LYNN TERESA (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:TERESA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:TERESA
Other - Last Name:LAVOIE-STEPHENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:1718 S OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-1722
Mailing Address - Country:US
Mailing Address - Phone:518-852-0712
Mailing Address - Fax:
Practice Address - Street 1:1718 S OLD POST RD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-1722
Practice Address - Country:US
Practice Address - Phone:518-852-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012568-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist