Provider Demographics
NPI:1992957385
Name:REMUND, STACIA MICHELE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:MICHELE
Last Name:REMUND
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 1:6 KINGS LN
Mailing Address - Street 2:
Mailing Address - City:SLATE HILL
Mailing Address - State:NY
Mailing Address - Zip Code:10973-4225
Mailing Address - Country:US
Mailing Address - Phone:917-903-4608
Mailing Address - Fax:
Practice Address - Street 1:6 KINGS LANE
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973
Practice Address - Country:US
Practice Address - Phone:917-903-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010109-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist