Provider Demographics
NPI:1922358480
Name:YORK, STEPHANIE NICOLE (CCC SLP)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:YORK
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3993 DEMONT ROAD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783
Mailing Address - Country:US
Mailing Address - Phone:516-592-1611
Mailing Address - Fax:
Practice Address - Street 1:145 ROSEMARY ST STE K1
Practice Address - Street 2:
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494-3259
Practice Address - Country:US
Practice Address - Phone:781-400-2482
Practice Address - Fax:317-815-3861
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist