Alice Karen Wynkoop
Individual provider Active NPI Speech-Language Pathologist · Stuyvesant, NY
NPI 1790094142 · NPPES record last updated Oct 4, 2010
Key facts
- NPI
- 1790094142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 005425-1 (NY)
- Practice address
- 16 Oak Leaf Dr
Stuyvesant, NY 12173-3109 - Phone
- (518) 799-3471
- NPI assigned
- Oct 4, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005425-1 | NY | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 005425-1 | NY | Yes |
Addresses
Primary practice location
16 Oak Leaf Dr
Stuyvesant, NY 12173-3109
Mailing address
16 Oak Leaf Dr
Stuyvesant, NY 12173-3109
Phone (518) 799-3471
Other names
- Mrs. Alice Karen Masella
Other providers in Stuyvesant, NY
All providers in Stuyvesant, NY · Speech-Language Pathologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.