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General NPI Number Information
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NPI Number | 1801030879
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Entity Type | Individual
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Provider Name | MISS STACIE H MASON
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Gender | Female
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 1717 BELLEVUE AVE
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City | RICHMOND
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State | VA
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Zip | 23227
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Country | US
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Telephone | 804-401-0405
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Fax |
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Provider Business Mailing Address
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Address Line | 9101 WESLEYAN RD STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-3103
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Country | US
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Telephone | 800-603-6046
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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 | 2202005268
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License Number State | VA
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