MEDICARE: MRS. STACEY R LESIEUR 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
1	235Z00000X	Speech-Language Pathologist	100116	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86725T	OTHER	TX	BCBS PROVIDER #

General Provider Information

NPI Number	:	1942219530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACEY R LESIEUR MS CCC-SLP

Provider Business Mailing Address
First Line	:	1490 E WHITESTONE BLVD
Second Line	:	STE 100
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2274
Country	:	US
Telephone Number	:	512-260-3300
Fax Number	:	512-260-3343

Provider Business Practice Location Address
First Line	:	1490 E WHITESTONE BLVD
Second Line	:	STE 100
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2274
Country	:	US
Telephone Number	:	512-260-3300
Fax Number	:	512-260-3343

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

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

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Directions to “ MRS. STACEY R LESIEUR MS CCC-SLP” Practice Location

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