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General NPI Number Information
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NPI Number | 1073135885
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Entity Type | Individual
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Provider Name | STACEY EDGAR SLS
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Gender | Female
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 112 RESERVOIR AVE
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City | MANCHESTER
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State | NH
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Zip | 03104-4468
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Country | US
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Telephone | 603-624-6352
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Fax |
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Provider Business Mailing Address
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Address Line | 20 HECKER ST
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City | MANCHESTER
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State | NH
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Zip | 03102-3975
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Country | US
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Telephone | 603-624-3600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number | 71891
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License Number State | NH
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