Provider Demographics
NPI:1184867103
Name:SHINABARGER, STACEY LYNN (CFY-SLP, TSLI)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LYNN
Last Name:SHINABARGER
Suffix:
Gender:F
Credentials:CFY-SLP, TSLI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6376 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2811
Mailing Address - Country:US
Mailing Address - Phone:269-544-3764
Mailing Address - Fax:269-544-3767
Practice Address - Street 1:6376 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2811
Practice Address - Country:US
Practice Address - Phone:269-544-3764
Practice Address - Fax:269-544-3767
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist