Provider Demographics
NPI:1477735033
Name:BICK, STACY A (SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:A
Last Name:BICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:A
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1809 CLARKSON ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:636-532-3211
Mailing Address - Fax:
Practice Address - Street 1:1809 CLARKSON ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:636-532-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist