Provider Demographics
NPI:1205098316
Name:ACKERMAN, STEPHANIE LEE (SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:98 OLD STONEWALL RD
Mailing Address - Street 2:
Mailing Address - City:HANNACROIX
Mailing Address - State:NY
Mailing Address - Zip Code:12087-1737
Mailing Address - Country:US
Mailing Address - Phone:518-719-1706
Mailing Address - Fax:
Practice Address - Street 1:98 OLD STONEWALL RD
Practice Address - Street 2:
Practice Address - City:HANNACROIX
Practice Address - State:NY
Practice Address - Zip Code:12087-1737
Practice Address - Country:US
Practice Address - Phone:518-719-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist