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NPI Code Detail

MEDICARE: MRS. STACIE LYNN REXROAD-COLE M.S., CCC-SLP

MEDICARE: MRS. STACIE LYNN REXROAD-COLE 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 PathologistSL007552PA

General Provider Information

NPI Number : 1659508463
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACIE LYNN REXROAD-COLE M.S., CCC-SLP
Provider Business Mailing Address
First Line : 2964 ASTER LN
Second Line :
City : LITITZ
State : PA
Zip : 17543-7737
Country : US
Telephone Number : 717-569-9977
Fax Number :
Provider Business Practice Location Address
First Line : 1800 VILLAGE CIR
Second Line :
City : LANCASTER
State : PA
Zip : 17603-2376
Country : US
Telephone Number : 717-509-8270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2009
Last Update Date : 06/18/2009

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