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NPI Code Detail

MEDICARE: MRS. STACEYANN WADE SHOEMAKE M.S. CCC-SLP

MEDICARE: MRS. STACEYANN WADE SHOEMAKE M.S. 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
1235Z00000XSpeech-Language Pathologist103343TX

General Provider Information

NPI Number : 1316227200
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACEYANN WADE SHOEMAKE M.S. CCC-SLP
Provider Business Mailing Address
First Line : 2607 HARDWOOD TRL
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-7583
Country : US
Telephone Number : 817-821-3397
Fax Number :
Provider Business Practice Location Address
First Line : 605 E BROAD ST
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-1794
Country : US
Telephone Number : 817-299-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2011
Last Update Date : 12/09/2025

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Directions to “ MRS. STACEYANN WADE SHOEMAKE M.S. CCC-SLP” Practice Location

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