Provider Demographics
NPI:1053678441
Name:WHITCOMB, STACY MAY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MAY
Last Name:WHITCOMB
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 1:202 E CHEYENNE MOUNTAIN BLVD
Mailing Address - Street 2:SUITE L
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3769
Mailing Address - Country:US
Mailing Address - Phone:719-538-8488
Mailing Address - Fax:719-538-8288
Practice Address - Street 1:202 E CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3769
Practice Address - Country:US
Practice Address - Phone:719-538-8488
Practice Address - Fax:719-538-8288
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO191237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist