Provider Demographics
NPI:1598802696
Name:WALSH, STACY PROSSER (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:PROSSER
Last Name:WALSH
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 1:915 BRIAR GREEN CT
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5149
Mailing Address - Country:US
Mailing Address - Phone:314-965-9669
Mailing Address - Fax:
Practice Address - Street 1:915 BRIAR GREEN CT
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-5149
Practice Address - Country:US
Practice Address - Phone:314-965-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist