Provider Demographics
NPI:1740567866
Name:PHELPS, STACY REBECCA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:REBECCA
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 NUGGET DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7439
Mailing Address - Country:US
Mailing Address - Phone:270-535-4821
Mailing Address - Fax:
Practice Address - Street 1:3517 NUGGET DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7439
Practice Address - Country:US
Practice Address - Phone:270-535-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist