Provider Demographics
NPI:1073894127
Name:DUBOIS, STACY M
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:M
Last Name:DUBOIS
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:PO BOX 17167
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-7167
Mailing Address - Country:US
Mailing Address - Phone:601-261-5995
Mailing Address - Fax:601-261-5335
Practice Address - Street 1:3901 HARDY ST STE 100
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1696
Practice Address - Country:US
Practice Address - Phone:601-261-5995
Practice Address - Fax:601-261-5335
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0602237700000X
LA1179237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist