Provider Demographics
NPI:1790174704
Name:STANIK, CONNIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:STANIK
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 1:16235 CROWL ST SE
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-8915
Mailing Address - Country:US
Mailing Address - Phone:330-257-4709
Mailing Address - Fax:
Practice Address - Street 1:125 CANTON RD NW
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1009
Practice Address - Country:US
Practice Address - Phone:330-627-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist