Provider Demographics
NPI:1710257050
Name:SIEGERS, STACY (MA,CCC/SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SIEGERS
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 1:3529 BURTON COVE RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-6130
Mailing Address - Country:US
Mailing Address - Phone:931-537-6761
Mailing Address - Fax:
Practice Address - Street 1:728 S JEFFERSON AVE STE 14
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4279
Practice Address - Country:US
Practice Address - Phone:931-201-9682
Practice Address - Fax:931-263-7570
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000004428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist