Provider Demographics
NPI:1992940167
Name:GEBERT, STEPHANIE C (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:GEBERT
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3010
Mailing Address - Country:US
Mailing Address - Phone:631-239-6058
Mailing Address - Fax:
Practice Address - Street 1:25 CHESTER ST
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3010
Practice Address - Country:US
Practice Address - Phone:631-239-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist