MEDICARE: MRS. DEBRA RICHISON STUCKEY MA, 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	593	AR

General Provider Information

NPI Number	:	1558577031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA RICHISON STUCKEY MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1109 ADELAIDE ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4259
Country	:	US
Telephone Number	:	479-573-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 ADELAIDE ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4259
Country	:	US
Telephone Number	:	479-573-0500
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/09/2007

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