Provider Demographics
NPI:1467767483
Name:CLEVENGER, STACY ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANN
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:9100 WHITE BLUFF RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4600
Mailing Address - Country:US
Mailing Address - Phone:912-335-8486
Mailing Address - Fax:912-335-3528
Practice Address - Street 1:9100 WHITE BLUFF RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4668
Practice Address - Country:US
Practice Address - Phone:912-335-8486
Practice Address - Fax:912-335-3528
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CASP 17914235Z00000X
GASLP 008056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist