Provider Demographics
NPI:1073011292
Name:MAHLER, STACEY LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:MAHLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:STIBORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CFY-SLP
Mailing Address - Street 1:7433 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-5554
Mailing Address - Country:US
Mailing Address - Phone:216-269-8840
Mailing Address - Fax:
Practice Address - Street 1:5393 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-1216
Practice Address - Country:US
Practice Address - Phone:216-838-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP13124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist