Provider Demographics
NPI:1255716635
Name:SMITH, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SMITH
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 1:150 STAHL RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1231
Mailing Address - Country:US
Mailing Address - Phone:716-629-3400
Mailing Address - Fax:
Practice Address - Street 1:4535 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-202-1161
Practice Address - Fax:716-202-4423
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist