Provider Demographics
NPI:1427533801
Name:FERNANDEZ, STACEY NICOLE (SLPA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:NICOLE
Last Name:FERNANDEZ
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 1:3402 BRASILIA
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1229
Mailing Address - Country:US
Mailing Address - Phone:956-572-1908
Mailing Address - Fax:888-388-8379
Practice Address - Street 1:524 E LOS EBANOS BLVD STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8433
Practice Address - Country:US
Practice Address - Phone:956-572-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353122355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35312OtherSLPA