Healthcare Provider Details

I. General information

NPI: 1821283763
Provider Name (Legal Business Name): STACI B BREWER MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACI B HARRIS MA, CCC-SLP

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 13TH ST
SAINT CLOUD FL
34769-4124
US

IV. Provider business mailing address

360 WESTYN BAY BLVD
OCOEE FL
34761-5013
US

V. Phone/Fax

Practice location:
  • Phone: 407-913-1010
  • Fax: 407-992-8697
Mailing address:
  • Phone: 407-913-1010
  • Fax: 407-992-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA9608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: