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General NPI Number Information
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NPI Number | 1811164890
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Entity Type | Individual
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Provider Name | KARLENE MARIE STACKHOUSE MA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 9 MILLARD ST
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City | DUNDEE
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State | NY
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Zip | 14837-1008
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Country | US
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Telephone | 607-377-7216
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Fax |
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Provider Business Mailing Address
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Address Line | 9 MILLARD ST
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City | DUNDEE
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State | NY
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Zip | 14837-1008
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Country | US
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Telephone | 607-377-7216
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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 | 4126
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 018603
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License Number State | NY
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