Provider Demographics
NPI:1477634384
Name:STEWART, STACEY DIANE (MSCCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:DIANE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSCCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 FACTORS WALK
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-0703
Mailing Address - Country:US
Mailing Address - Phone:615-418-7705
Mailing Address - Fax:
Practice Address - Street 1:301 HIGH HOPES CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1452
Practice Address - Country:US
Practice Address - Phone:615-661-5437
Practice Address - Fax:615-277-2838
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist