MEDICARE: MRS. STACEYANN WADE SHOEMAKE 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
1	235Z00000X	Speech-Language Pathologist	103343	TX

General Provider Information

NPI Number	:	1316227200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACEYANN WADE SHOEMAKE M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2607 HARDWOOD TRL
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7583
Country	:	US
Telephone Number	:	817-821-3397
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 E BROAD ST
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1794
Country	:	US
Telephone Number	:	817-299-6300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	12/09/2025

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