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NPI Code Detail

MEDICARE: STACY ORSBURN MS CCC/SLP

MEDICARE: STACY ORSBURN MS 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 Pathologist16619TX

General Provider Information

NPI Number : 1366759268
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY ORSBURN MS CCC/SLP
Provider Business Mailing Address
First Line : HC 73 BOX 834
Second Line : 1202 LIMESTONE RD
City : KINGSTON
State : OK
Zip : 73439-8728
Country : US
Telephone Number : 580-564-1554
Fax Number :
Provider Business Practice Location Address
First Line : 601 E US HIGHWAY 69
Second Line :
City : DENISON
State : TX
Zip : 75021-6510
Country : US
Telephone Number : 903-465-2438
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2010
Last Update Date : 09/13/2010

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Directions to “ STACY ORSBURN MS CCC/SLP” Practice Location

Language Start Address Practice Location
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