Provider Demographics
NPI:1750651873
Name:EGGLESTON, STACIA NICHOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:NICHOLE
Last Name:EGGLESTON
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 1:2128 BLUEBALL AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3620
Mailing Address - Country:US
Mailing Address - Phone:610-485-4240
Mailing Address - Fax:
Practice Address - Street 1:2128 BLUEBALL AVE
Practice Address - Street 2:
Practice Address - City:UPPER CHICHESTER
Practice Address - State:PA
Practice Address - Zip Code:19061-3620
Practice Address - Country:US
Practice Address - Phone:610-485-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011663235Z00000X
DEO1-0001348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist