Basic Information
| Provider Information | |||||||||
| NPI: | 1922358480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YORK | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3993 DEMONT ROAD | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165921611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 145 ROSEMARY ST STE K1 | ||||||||
| Address2: | |||||||||
| City: | NEEDHAM HEIGHTS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024943259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814002482 | ||||||||
| FaxNumber: | 3178153861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 022131 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.