Provider Demographics
NPI:1073722245
Name:NEASE, STACY DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:DAWN
Last Name:NEASE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9135
Mailing Address - Country:US
Mailing Address - Phone:580-319-4800
Mailing Address - Fax:
Practice Address - Street 1:3200 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-9135
Practice Address - Country:US
Practice Address - Phone:580-319-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist