MEDICARE: STACIE CUMMINGS JEMPTY 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

General Provider Information

NPI Number	:	1366759136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE CUMMINGS JEMPTY SLP

Provider Business Mailing Address
First Line	:	205 E WALNUT DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-5642
Country	:	US
Telephone Number	:	850-258-4364
Fax Number	:

Provider Business Practice Location Address
First Line	:	11113 RESEARCH BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-5236
Country	:	US
Telephone Number	:	512-324-6000
Fax Number	:	512-324-6576

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	08/31/2021

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Directions to “ STACIE CUMMINGS JEMPTY SLP” Practice Location

Language	Start Address	Practice Location

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