Provider Demographics
NPI:1689234593
Name:MCCARTHY, STACY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MCCARTHY
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 1:6330 E 75TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2700
Mailing Address - Country:US
Mailing Address - Phone:317-284-1166
Mailing Address - Fax:
Practice Address - Street 1:7594 S 100 E
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-9398
Practice Address - Country:US
Practice Address - Phone:765-623-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007212A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist