Provider Demographics
NPI:1447554829
Name:STAPLETON, JULIE LYND (MA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LYND
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ERIN
Other - Last Name:LYND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 PONDS WAY
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-9411
Mailing Address - Country:US
Mailing Address - Phone:585-489-6462
Mailing Address - Fax:
Practice Address - Street 1:149 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1434
Practice Address - Country:US
Practice Address - Phone:585-377-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008138-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist