Provider Demographics
NPI:1831354984
Name:STAEBELL, MARY MARGARET (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:STAEBELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-1003
Mailing Address - Country:US
Mailing Address - Phone:716-542-5183
Mailing Address - Fax:
Practice Address - Street 1:25 CHATEAU TER
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3927
Practice Address - Country:US
Practice Address - Phone:716-839-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018386-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist