Provider Demographics
NPI:1578688842
Name:SOOS, STACEY MARIE (SLPD, CC-SLP)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MARIE
Last Name:SOOS
Suffix:
Gender:F
Credentials:SLPD, CC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SADDLE RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8203
Mailing Address - Country:US
Mailing Address - Phone:717-406-9433
Mailing Address - Fax:
Practice Address - Street 1:609 SADDLE RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-8203
Practice Address - Country:US
Practice Address - Phone:717-406-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty