Provider Demographics
NPI:1255619599
Name:DEENEY, STEPHANIE KAY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:DEENEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHASE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9700
Mailing Address - Country:US
Mailing Address - Phone:585-943-9871
Mailing Address - Fax:
Practice Address - Street 1:4 CHASE VIEW RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-943-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021139-1235Z00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist