Provider Demographics
NPI:1114010212
Name:WHITEAMIRE, STACEY L (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:WHITEAMIRE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ERIE CT
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1724
Mailing Address - Country:US
Mailing Address - Phone:440-984-2416
Mailing Address - Fax:440-984-2422
Practice Address - Street 1:150 ERIE CT
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1724
Practice Address - Country:US
Practice Address - Phone:440-984-2416
Practice Address - Fax:440-984-2422
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7255198Medicaid
OH7255198Medicaid