MEDICARE: MRS. STACY BASTIEN-RENELIQUE M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		NY

General Provider Information

NPI Number	:	1134374580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY BASTIEN-RENELIQUE M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2066 PEARSON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4727
Country	:	US
Telephone Number	:	347-885-5601
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 LIVINGSTON ST
Second Line	:	SUITE 1101
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1260
Country	:	US
Telephone Number	:	718-625-4055
Fax Number	:	718-625-4702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2008
Last Update Date	:	01/29/2014

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Directions to “ MRS. STACY BASTIEN-RENELIQUE M.S. CCC-SLP” Practice Location

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