MEDICARE: KATHRYN BETSY STOUDT

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	035675	NY

General Provider Information

NPI Number	:	1003790106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN BETSY STOUDT

Provider Business Mailing Address
First Line	:	2 W 120TH ST APT 3I
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-6377
Country	:	US
Telephone Number	:	407-455-3361
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W 169TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3913
Country	:	US
Telephone Number	:	212-740-4701
Fax Number	:	212-740-4706

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

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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Directions to “ KATHRYN BETSY STOUDT ” Practice Location

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