Provider Demographics
NPI:1255344487
Name:MCKIERNAN STUART, CAROLINE E
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:E
Last Name:MCKIERNAN STUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5337
Mailing Address - Country:US
Mailing Address - Phone:716-649-0682
Mailing Address - Fax:
Practice Address - Street 1:6490 TAYLOR RD LOT 17
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-6565
Practice Address - Country:US
Practice Address - Phone:877-246-2396
Practice Address - Fax:877-246-2396
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010102-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist