MEDICARE: STACY LEIGH HAYES

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	1563	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5W864	OTHER	AR	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1518916550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY LEIGH HAYES

Provider Business Mailing Address
First Line	:	74 E 26TH CIR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-7551
Country	:	US
Telephone Number	:	479-582-5986
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 WOODLAND AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703
Country	:	US
Telephone Number	:	479-443-4420
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/08/2007

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Directions to “ STACY LEIGH HAYES ” Practice Location

Language	Start Address	Practice Location

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