Provider Demographics
NPI:1609303916
Name:SILVERMAN, STACEY ARTHUR (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ARTHUR
Last Name:SILVERMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12728 RUEDA MELILLA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1717
Mailing Address - Country:US
Mailing Address - Phone:832-821-6757
Mailing Address - Fax:
Practice Address - Street 1:12728 RUEDA MELILLA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-1717
Practice Address - Country:US
Practice Address - Phone:832-821-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107064235Z00000X
CA24911235Z00000X
GASLP009568235Z00000X
NE1928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist