Provider Demographics
NPI:1730467101
Name:CONFORT, STACEY R (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:R
Last Name:CONFORT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:CONFORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:15245 SHADY GROVE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7202
Mailing Address - Country:US
Mailing Address - Phone:301-654-1666
Mailing Address - Fax:301-654-7175
Practice Address - Street 1:5530 WISCONSIN AVE STE 1528
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4300
Practice Address - Country:US
Practice Address - Phone:301-654-1666
Practice Address - Fax:301-654-7175
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist