Provider Demographics
NPI:1003938085
Name:GREENE, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 LACKAWANNA RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1914
Mailing Address - Country:US
Mailing Address - Phone:859-599-3019
Mailing Address - Fax:859-533-3019
Practice Address - Street 1:436 HOUSTON OAKS DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2704
Practice Address - Country:US
Practice Address - Phone:606-584-1169
Practice Address - Fax:606-763-6245
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist