Provider Demographics
NPI:1851691414
Name:STAMM DELLA FERA, MARGUERITE (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:
Last Name:STAMM DELLA FERA
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE ON DELAWARE
Mailing Address - State:PA
Mailing Address - Zip Code:18356-0123
Mailing Address - Country:US
Mailing Address - Phone:570-421-5098
Mailing Address - Fax:570-421-5098
Practice Address - Street 1:4578 OAKWOOD LN
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8670
Practice Address - Country:US
Practice Address - Phone:732-804-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009779235Z00000X
NJ41YS00568200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist