Provider Demographics
NPI:1942493820
Name:WALBERG, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:WALBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:MCGUIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:6091 S QUEBEC ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4521
Mailing Address - Country:US
Mailing Address - Phone:303-504-9945
Mailing Address - Fax:303-504-9946
Practice Address - Street 1:6091 S QUEBEC ST
Practice Address - Street 2:STE 200
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4521
Practice Address - Country:US
Practice Address - Phone:303-504-9945
Practice Address - Fax:303-504-9946
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29577039Medicaid
COC483698Medicare PIN