Provider Demographics
NPI:1487041091
Name:CRAFT, STACY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:CRAFT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 DUNLAP RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8665
Mailing Address - Country:US
Mailing Address - Phone:740-981-4358
Mailing Address - Fax:
Practice Address - Street 1:2325 COUNTY ROAD 26 UNIT A
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-9075
Practice Address - Country:US
Practice Address - Phone:740-532-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist