MEDICARE: STACY R CLIVER 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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1609537315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY R CLIVER M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	196 FOREST BEND LN
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-3603
Country	:	US
Telephone Number	:	702-858-2324
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 BAILEY RANCH RD
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-3110
Country	:	US
Telephone Number	:	702-858-2324
Fax Number	:

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

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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Directions to “ STACY R CLIVER M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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