Provider Demographics
NPI:1720700305
Name:STACK, JULIA M (MS,CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:M
Last Name:STACK
Suffix:
Gender:F
Credentials:MS,CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 ALBION OVAL
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-3601
Mailing Address - Country:US
Mailing Address - Phone:845-531-1140
Mailing Address - Fax:
Practice Address - Street 1:3151 STONY ST
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1913
Practice Address - Country:US
Practice Address - Phone:914-885-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist