Provider Demographics
NPI:1043752330
Name:POLLAK, STEPHANIE (MSED CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:POLLAK
Suffix:
Gender:F
Credentials:MSED CF-SLP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:DE LUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 GLENBURNIE DR
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1482
Mailing Address - Country:US
Mailing Address - Phone:518-816-2504
Mailing Address - Fax:
Practice Address - Street 1:69 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-3900
Practice Address - Country:US
Practice Address - Phone:518-668-5714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025734124Q00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No124Q00000XDental ProvidersDental Hygienist