Provider Demographics
NPI:1457503963
Name:MARCUCCI, STACY JORDAN (MS/SLP)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:JORDAN
Last Name:MARCUCCI
Suffix:
Gender:F
Credentials:MS/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WEST VALLEY FORGE ROAD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1571
Mailing Address - Country:US
Mailing Address - Phone:610-337-1775
Mailing Address - Fax:
Practice Address - Street 1:600 WEST VALLEY FORGE ROAD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1571
Practice Address - Country:US
Practice Address - Phone:610-337-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist