Provider Demographics
NPI:1053866111
Name:REZEK, STACY (SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:REZEK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11189 S HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7153
Mailing Address - Country:US
Mailing Address - Phone:913-424-7599
Mailing Address - Fax:
Practice Address - Street 1:128 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3453
Practice Address - Country:US
Practice Address - Phone:913-488-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1581235Z00000X
CA24346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist