Provider Demographics
NPI:1154848661
Name:MATE, STACY MARIE
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:MATE
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 1:1689 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-8716
Mailing Address - Country:US
Mailing Address - Phone:440-994-9196
Mailing Address - Fax:
Practice Address - Street 1:111 W GRAND VALLEY AVE
Practice Address - Street 2:
Practice Address - City:ORWELL
Practice Address - State:OH
Practice Address - Zip Code:44076-9437
Practice Address - Country:US
Practice Address - Phone:440-805-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2017342-SP235Z00000X
OHSP.13113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist