Provider Demographics
NPI:1740426295
Name:STUART, DEANNA MARIE (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MISS
First Name:DEANNA
Middle Name:MARIE
Last Name:STUART
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 CYPRESS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2149
Mailing Address - Country:US
Mailing Address - Phone:314-440-4619
Mailing Address - Fax:
Practice Address - Street 1:745 JEFFCO BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010
Practice Address - Country:US
Practice Address - Phone:636-296-8000
Practice Address - Fax:636-282-5170
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist