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General NPI Number Information
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NPI Number | 1508201278
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Entity Type | Individual
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Provider Name | AMANDA LAUREN STOLCZ
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Gender | Female
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 4223 FRANCIS LEWIS BLVD LL107
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City | BAYSIDE
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State | NY
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Zip | 11361-2575
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Country | US
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Telephone | 718-767-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 8629 155TH AVE APT. 5K
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City | HOWARD BEACH
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State | NY
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Zip | 11414-2109
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Country | US
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Telephone | 917-846-2428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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