Provider Demographics
NPI:1326365107
Name:EDWARDS, STACEY MARGARETTE (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARGARETTE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 E TUMBLE WEED RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-9027
Mailing Address - Country:US
Mailing Address - Phone:928-277-3373
Mailing Address - Fax:
Practice Address - Street 1:7626 E TUMBLE WEED RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-9027
Practice Address - Country:US
Practice Address - Phone:928-277-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA66752355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant