Provider Demographics
NPI:1518325299
Name:BLALOCK, STACY (AUD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:BLALOCK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:MCINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1600 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3223
Mailing Address - Country:US
Mailing Address - Phone:601-693-0960
Mailing Address - Fax:601-483-9664
Practice Address - Street 1:1600 22ND AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3223
Practice Address - Country:US
Practice Address - Phone:601-483-5322
Practice Address - Fax:601-553-2955
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3027231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist