Provider Demographics
NPI:1366696163
Name:KLEIN, STEPHANIE ANN (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ANN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 QUEENS BLVD
Mailing Address - Street 2:#2A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5473
Mailing Address - Country:US
Mailing Address - Phone:718-520-7903
Mailing Address - Fax:
Practice Address - Street 1:18508 UNION TPKE
Practice Address - Street 2:#105
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1700
Practice Address - Country:US
Practice Address - Phone:718-264-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011178OtherNYS DEPARTMENT OF HEALTH