Provider Demographics
NPI:1689997421
Name:HAMETZ, STACEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:HAMETZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:GRANITE SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:10527-1011
Mailing Address - Country:US
Mailing Address - Phone:914-556-6009
Mailing Address - Fax:
Practice Address - Street 1:14 COTTAGE PL
Practice Address - Street 2:
Practice Address - City:GRANITE SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:10527-1011
Practice Address - Country:US
Practice Address - Phone:914-556-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist