Provider Demographics
NPI:1487935847
Name:STEIN, JUDITH E (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:STEIN
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 1:104 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4935
Mailing Address - Country:US
Mailing Address - Phone:631-499-5404
Mailing Address - Fax:631-462-0621
Practice Address - Street 1:104 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-4935
Practice Address - Country:US
Practice Address - Phone:631-499-5404
Practice Address - Fax:631-462-0621
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2813235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist