Provider Demographics
NPI:1942515564
Name:SPORN, STEPHANIE KREISBERG (MA,CCC/SPL)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KREISBERG
Last Name:SPORN
Suffix:
Gender:F
Credentials:MA,CCC/SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20017 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1007
Mailing Address - Country:US
Mailing Address - Phone:718-224-9701
Mailing Address - Fax:
Practice Address - Street 1:77-40 VLEIGH PLACE
Practice Address - Street 2:STEPPINGSTONE DAY SCHOOL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367
Practice Address - Country:US
Practice Address - Phone:718-591-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001259-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist