Provider Demographics
NPI:1891965885
Name:FRETHEIM, STACY LYNNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNNE
Last Name:FRETHEIM
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 1:9821 E BELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2344
Mailing Address - Country:US
Mailing Address - Phone:480-629-4461
Mailing Address - Fax:480-629-5898
Practice Address - Street 1:9821 E BELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2344
Practice Address - Country:US
Practice Address - Phone:480-629-4461
Practice Address - Fax:480-629-5898
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist