Provider Demographics
NPI:1205057460
Name:STACHOWSKI, CLAUDIA C (MED, SLP)
Entity type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:C
Last Name:STACHOWSKI
Suffix:
Gender:F
Credentials:MED, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 GOODRICH RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1203
Mailing Address - Country:US
Mailing Address - Phone:716-741-2814
Mailing Address - Fax:
Practice Address - Street 1:5280 GOODRICH RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1203
Practice Address - Country:US
Practice Address - Phone:716-741-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002742-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000640203002OtherBLUECROSS BLUESHIELD WNY
NY00026626201OtherUNIVERA HEALTHCARE
11516072OtherCAQH PROVIDER ID
NY9290070OtherINDEPENDENT HEALTH
11516072OtherCAQH PROVIDER ID