Provider Demographics
NPI:1083089064
Name:CHAMBERLAIN, STACEY (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10652 BOCA ENTRADA BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5872
Mailing Address - Country:US
Mailing Address - Phone:407-879-3504
Mailing Address - Fax:
Practice Address - Street 1:1955 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1028
Practice Address - Country:US
Practice Address - Phone:953-580-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist