Provider Demographics
NPI:1861688715
Name:FOREMAN, STACY (MS CCC LSLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:MS CCC LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17007-9531
Mailing Address - Country:US
Mailing Address - Phone:717-245-0922
Mailing Address - Fax:
Practice Address - Street 1:614 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9531
Practice Address - Country:US
Practice Address - Phone:717-245-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003544L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017697870003Medicare PIN