Provider Demographics
NPI:1376824532
Name:STEVENS, JOANNE KOWALCZYK (M A CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:KOWALCZYK
Last Name:STEVENS
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2417
Mailing Address - Country:US
Mailing Address - Phone:315-469-4791
Mailing Address - Fax:
Practice Address - Street 1:725 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2395
Practice Address - Country:US
Practice Address - Phone:315-435-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0031721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0031721Medicaid
NY00444828Medicare Oscar/Certification