Basic Information
| Provider Information | |||||||||
| NPI: | 1992966907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 838 CARLTON BLVD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103123337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182279870 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2534 STEINWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111033702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187775243 | ||||||||
| FaxNumber: | 7187775250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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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 | 014680-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.