Provider Demographics
NPI:1003000456
Name:HOBAN, STACIE ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:ANN
Last Name:HOBAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OCEAN AVE
Mailing Address - Street 2:SPEECH AND LANGUAGE
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3675
Mailing Address - Country:US
Mailing Address - Phone:781-485-6131
Mailing Address - Fax:
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:SPEECH AND LANGUAGE
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3675
Practice Address - Country:US
Practice Address - Phone:781-485-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist