Provider Demographics
NPI:1508014887
Name:NUNNELEE, STACY LALISE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LALISE
Last Name:NUNNELEE
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 305010
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76203-5010
Mailing Address - Country:US
Mailing Address - Phone:940-565-2262
Mailing Address - Fax:
Practice Address - Street 1:907 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4049
Practice Address - Country:US
Practice Address - Phone:940-565-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist