MEDICARE: STACY FOREMAN MS CCC LSLP

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	SL003544L	PA

General Provider Information

NPI Number	:	1861688715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY FOREMAN MS CCC LSLP

Provider Business Mailing Address
First Line	:	614 MOUNTAIN RD
Second Line	:
City	:	BOILING SPRINGS
State	:	PA
Zip	:	17007-9531
Country	:	US
Telephone Number	:	717-245-0922
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 MOUNTAIN RD
Second Line	:
City	:	BOILING SPRINGS
State	:	PA
Zip	:	17007-9531
Country	:	US
Telephone Number	:	717-245-0922
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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