Provider Demographics
NPI:1609112663
Name:SARACENO, STACY ANN (SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:SARACENO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:YELVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3900 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3466
Practice Address - Country:US
Practice Address - Phone:916-481-6455
Practice Address - Fax:877-738-4262
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist