Provider Demographics
NPI:1932118395
Name:MELTZER, STACY B (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:B
Last Name:MELTZER
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 1:15338 LAKE WILDFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-4649
Mailing Address - Country:US
Mailing Address - Phone:561-499-9740
Mailing Address - Fax:
Practice Address - Street 1:15338 LAKE WILDFLOWER RD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-4649
Practice Address - Country:US
Practice Address - Phone:561-499-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist