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NPI Code Detail

MEDICARE: MRS. STACY L DALTON M.S. CCC-SLP

MEDICARE: MRS. STACY L DALTON M.S. CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist1720AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15W448OTHERARBLUE CROSS NUMBER

General Provider Information

NPI Number : 1124222385
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY L DALTON M.S. CCC-SLP
Provider Business Mailing Address
First Line : 1401 WESTHAMPTON DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-4069
Country : US
Telephone Number : 501-223-9104
Fax Number :
Provider Business Practice Location Address
First Line : 1401 WESTHAMPTON DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-4069
Country : US
Telephone Number : 501-223-9104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. STACY L DALTON M.S. CCC-SLP” Practice Location

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