Provider Demographics
NPI:1467426155
Name:CULVER, STACEY S (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:S
Last Name:CULVER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 WINDJAMMER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4443
Mailing Address - Country:US
Mailing Address - Phone:202-276-8958
Mailing Address - Fax:
Practice Address - Street 1:3070 WINDJAMMER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4443
Practice Address - Country:US
Practice Address - Phone:202-276-8958
Practice Address - Fax:781-647-8914
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6636235Z00000X
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200445Medicaid