Provider Demographics
NPI:1326173865
Name:ZILL, STACY (MSLPCCCSLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ZILL
Suffix:
Gender:F
Credentials:MSLPCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023-9718
Mailing Address - Country:US
Mailing Address - Phone:412-860-9120
Mailing Address - Fax:
Practice Address - Street 1:105 S PIKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9283
Practice Address - Country:US
Practice Address - Phone:724-353-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007570235Z00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist