Provider Demographics
NPI:1497957245
Name:KEITH, STACEY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:KEITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 PEMBERTON HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4278
Mailing Address - Country:US
Mailing Address - Phone:919-372-5489
Mailing Address - Fax:866-889-4751
Practice Address - Street 1:1031 PEMBERTON HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4278
Practice Address - Country:US
Practice Address - Phone:919-372-5489
Practice Address - Fax:866-889-4751
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73742081P0010X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine