Provider Demographics
NPI:1710269998
Name:CROSS, M. STEPHANIE
Entity Type:Individual
Prefix:MRS
First Name:M.
Middle Name:STEPHANIE
Last Name:CROSS
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 1:3844 POMPEY CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-8709
Mailing Address - Country:US
Mailing Address - Phone:315-682-0586
Mailing Address - Fax:
Practice Address - Street 1:3844 POMPEY CENTER RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-8709
Practice Address - Country:US
Practice Address - Phone:315-682-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004286-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist