Provider Demographics
NPI:1528395274
Name:FOX, STACIE ANN (SLPD CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:ANN
Last Name:FOX
Suffix:
Gender:F
Credentials:SLPD CCC-SLP
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:ANN
Other - Last Name:GREENWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:200 EXECUTIVE CENTER PARKWAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:540-446-2654
Mailing Address - Fax:540-993-1081
Practice Address - Street 1:200 EXECUTIVE CENTER PARKWAY
Practice Address - Street 2:SUITE 106
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-446-2654
Practice Address - Fax:540-993-1081
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist