Provider Demographics
NPI:1225360134
Name:TYNDALL, STACEY COUEY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:COUEY
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:STEDMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28391-8835
Mailing Address - Country:US
Mailing Address - Phone:910-223-0471
Mailing Address - Fax:
Practice Address - Street 1:7007 CLINTON RD
Practice Address - Street 2:
Practice Address - City:STEDMAN
Practice Address - State:NC
Practice Address - Zip Code:28391-8835
Practice Address - Country:US
Practice Address - Phone:910-223-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12057951OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
NC5831OtherBOARD OF EXAMINERS FOR SPEECH AND LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS