Provider Demographics
NPI:1326189523
Name:PRYOR, STACY PERINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:PERINE
Last Name:PRYOR
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 1:1006 TULIPTREE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2518
Mailing Address - Country:US
Mailing Address - Phone:281-221-4884
Mailing Address - Fax:281-880-4851
Practice Address - Street 1:16903 RED OAK DR
Practice Address - Street 2:SUITE 207
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3914
Practice Address - Country:US
Practice Address - Phone:281-221-4884
Practice Address - Fax:281-880-4851
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist