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General NPI Number Information
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NPI Number | 1710666953
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Entity Type | Individual
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Provider Name | OLIVIA STUCKLEY
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Gender | Female
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 100 NEWHAVEN LN
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City | BUTLER
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State | PA
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Zip | 16001-7926
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Country | US
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Telephone | 724-477-8701
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 STRASSNER DRIVE
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City | BRENTWOOD
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State | MO
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Zip | 63144
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL015626
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License Number State | PA
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