MEDICARE: STEFANIE MILRUD

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	41YS00857600	NJ

General Provider Information

NPI Number	:	1699493494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE MILRUD

Provider Business Mailing Address
First Line	:	21 JENNIFER CT
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1633
Country	:	US
Telephone Number	:	646-330-0853
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 JENNIFER CT
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1633
Country	:	US
Telephone Number	:	646-330-0853
Fax Number	:

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

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	08/17/2022

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Directions to “ STEFANIE MILRUD ” Practice Location

Language	Start Address	Practice Location

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