Provider Demographics
NPI:1659923837
Name:FOJTIK, STACEY MARIE (MS-SLP-CCC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:FOJTIK
Suffix:
Gender:F
Credentials:MS-SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N AVE D
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984
Mailing Address - Country:US
Mailing Address - Phone:361-401-0304
Mailing Address - Fax:
Practice Address - Street 1:711 N AVE D
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-5424
Practice Address - Country:US
Practice Address - Phone:361-401-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114612235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist