Healthcare Provider Details

I. General information

NPI: 1538242276
Provider Name (Legal Business Name): STACIE KAMMER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST STE C
GREENVILLE OH
45331-1396
US

IV. Provider business mailing address

9939 DETLING RD
ANSONIA OH
45303-9736
US

V. Phone/Fax

Practice location:
  • Phone: 937-547-2319
  • Fax: 937-548-4248
Mailing address:
  • Phone: 937-548-9495
  • Fax: 937-548-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.07455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: