Provider Demographics
NPI:1043955016
Name:STACY'S SPEECH
Entity Type:Organization
Organization Name:STACY'S SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC/SLP
Authorized Official - Phone:606-438-5431
Mailing Address - Street 1:PO BOX 1145
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822-1145
Mailing Address - Country:US
Mailing Address - Phone:606-438-5431
Mailing Address - Fax:
Practice Address - Street 1:2495 HWY 899
Practice Address - Street 2:
Practice Address - City:MALLIE
Practice Address - State:KY
Practice Address - Zip Code:41836
Practice Address - Country:US
Practice Address - Phone:606-438-5431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty