Provider Demographics
NPI:1477958825
Name:FITTON, STACEY L (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:L
Last Name:FITTON
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:STOBIERSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:15 RESEARCH DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2356
Mailing Address - Country:US
Mailing Address - Phone:203-387-1401
Mailing Address - Fax:203-387-1415
Practice Address - Street 1:15 RESEARCH DR
Practice Address - Street 2:UNIT 1
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2356
Practice Address - Country:US
Practice Address - Phone:203-387-1401
Practice Address - Fax:203-387-1415
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14055900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist