Healthcare Provider Details

I. General information

NPI: 1467852681
Provider Name (Legal Business Name): STACI DILLIE M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N TYLER ST
LITTLE ROCK AR
72205-3535
US

IV. Provider business mailing address

824 N TYLER ST
LITTLE ROCK AR
72205-3535
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-2961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#P8848
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: