Provider Demographics
NPI:1376831958
Name:PICCONE, STACEY
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:PICCONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MEDICAL CENTER PT
Mailing Address - Street 2:STE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5798
Mailing Address - Country:US
Mailing Address - Phone:719-635-5148
Mailing Address - Fax:719-448-0164
Practice Address - Street 1:2 S CASCADE AVE
Practice Address - Street 2:STE 140
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1624
Practice Address - Country:US
Practice Address - Phone:719-538-2900
Practice Address - Fax:719-538-2987
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60230650231H00000X
COAUD.0000764231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist