Provider Demographics
NPI:1164817383
Name:MELTON, STACEY ALEXANDRIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ALEXANDRIA
Last Name:MELTON
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 1:1203 S FLORENCE PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4110
Mailing Address - Country:US
Mailing Address - Phone:918-978-0098
Mailing Address - Fax:
Practice Address - Street 1:2619 E 14TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4707
Practice Address - Country:US
Practice Address - Phone:719-351-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist