Provider Demographics
NPI:1902009657
Name:HIRSCH, STACIE ALYSIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:ALYSIA
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TALLANT RD
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:TN
Mailing Address - Zip Code:37353-5511
Mailing Address - Country:US
Mailing Address - Phone:865-386-5970
Mailing Address - Fax:
Practice Address - Street 1:399 TALLANT RD
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:TN
Practice Address - Zip Code:37353-5511
Practice Address - Country:US
Practice Address - Phone:865-386-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist