Stacy Lorraine Richard

Individual provider Active NPI Speech-Language Pathologist · Frankfort, NY

NPI 1265869531 · NPPES record last updated Oct 2, 2013

Key facts

NPI
1265869531
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
023212-1 (NY)
Practice address
325 5TH Ave
Frankfort, NY 13340-3622
Phone
(315) 717-7442
Fax
(315) 895-0062
NPI assigned
Oct 2, 2013
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
023212-1NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Simply Special Early Learning Center LLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 023212-1 NY Yes

Addresses

Primary practice location

325 5TH Ave
Frankfort, NY 13340-3622

Mailing address

325 5TH Ave
Frankfort, NY 13340-3622
Phone (315) 717-7442

Other providers in Frankfort, NY

All providers in Frankfort, NY · Speech-Language Pathologist in New York

Sources for this page

Verify at the official NPI Registry.