Provider Demographics
NPI:1437517869
Name:OWENS-HOWARD, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:OWENS-HOWARD
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 1:721 CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6807
Mailing Address - Country:US
Mailing Address - Phone:910-219-8603
Mailing Address - Fax:910-219-8604
Practice Address - Street 1:1249 HARGETT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5934
Practice Address - Country:US
Practice Address - Phone:910-219-8603
Practice Address - Fax:910-378-7727
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist