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General NPI Number Information
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NPI Number | 1043955016
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Entity Type | Organization
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Legal Business Name | STACY'S SPEECH
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 2495 HWY 899
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City | MALLIE
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State | KY
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Zip | 41836
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Country | US
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Telephone | 606-438-5431
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1145
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City | HINDMAN
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State | KY
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Zip | 41822-1145
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Country | US
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Telephone | 606-438-5431
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | STACY LYNN BURNETT
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Credential | M.A. CCC/SLP
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Telephone | 606-438-5431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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