Provider Demographics
NPI:1326347824
Name:BRIOLO, STACEY (ST)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BRIOLO
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 N PARKERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2001
Mailing Address - Country:US
Mailing Address - Phone:985-855-1676
Mailing Address - Fax:
Practice Address - Street 1:2122 N PARKERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2001
Practice Address - Country:US
Practice Address - Phone:985-855-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist