Provider Demographics
NPI:1023196714
Name:ANDERSON, STACY AMANDA (MS CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:AMANDA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 THOMAS HILL WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917
Mailing Address - Country:US
Mailing Address - Phone:865-525-3216
Mailing Address - Fax:
Practice Address - Street 1:809 E EMERALD AVE
Practice Address - Street 2:NATIONAL HEALTHCARE
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917
Practice Address - Country:US
Practice Address - Phone:865-524-7366
Practice Address - Fax:865-637-4402
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist