Provider Demographics
NPI:1720398571
Name:TRUBIA, STEPHANIE JILL (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JILL
Last Name:TRUBIA
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9733
Mailing Address - Country:US
Mailing Address - Phone:315-218-2600
Mailing Address - Fax:
Practice Address - Street 1:7180 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9733
Practice Address - Country:US
Practice Address - Phone:315-218-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58009187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist