Healthcare Provider Details

I. General information

NPI: 1710069745
Provider Name (Legal Business Name): STACY L BLACKINGTON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E PRIMROSE ST
SPRINGFIELD MO
65807-5155
US

IV. Provider business mailing address

1001 E PRIMROSE ST
SPRINGFIELD MO
65807-5155
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3600
  • Fax:
Mailing address:
  • Phone: 417-875-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2002019898
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2002019898
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: