MEDICARE: MRS. STEPHANIE BAKER KENNEDY MS, 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	58 017283	NY

General Provider Information

NPI Number	:	1508170549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE BAKER KENNEDY MS, CCC-SLP

Provider Business Mailing Address
First Line	:	606 SARA CIR
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-2742
Country	:	US
Telephone Number	:	631-828-8510
Fax Number	:

Provider Business Practice Location Address
First Line	:	10600 YORK RD
Second Line	:	SUITE 105
City	:	COCKEYSVILLE
State	:	MD
Zip	:	21030-2351
Country	:	US
Telephone Number	:	631-608-5630
Fax Number	:

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

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	08/02/2010

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Directions to “ MRS. STEPHANIE BAKER KENNEDY MS, CCC-SLP” Practice Location

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