MEDICARE: STEPHANIE AUTUMN SMITH 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	027403-1	NY
2	235Z00000X	Speech-Language Pathologist	8790	MA
3	235Z00000X	Speech-Language Pathologist	146.018334	IL

General Provider Information

NPI Number	:	1215470687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE AUTUMN SMITH M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1560 MAYFLOWER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 N CLYBOURN AVE # 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3193
Country	:	US
Telephone Number	:	773-377-5492
Fax Number	:

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

Provider Enumeration Date	:	12/02/2016
Last Update Date	:	05/13/2025

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Directions to “ STEPHANIE AUTUMN SMITH M.S., CCC-SLP” Practice Location

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