Provider Demographics
NPI:1346519907
Name:TURNBOW, STACIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:TURNBOW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 MORRIS AVE APT 1205
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6602
Mailing Address - Country:US
Mailing Address - Phone:972-741-3097
Mailing Address - Fax:972-736-2271
Practice Address - Street 1:3200 BROADWAY BLVD.
Practice Address - Street 2:SUITE 250
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1570
Practice Address - Country:US
Practice Address - Phone:972-741-3097
Practice Address - Fax:972-736-2271
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106484235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106484OtherLICENSE