Provider Demographics
NPI:1023193919
Name:HAUERLAND, STACI MICHELLE (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:MICHELLE
Last Name:HAUERLAND
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 1:13815 ROLLING RIVER LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-2052
Mailing Address - Country:US
Mailing Address - Phone:281-225-7740
Mailing Address - Fax:
Practice Address - Street 1:5313 DECKER DR.
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520
Practice Address - Country:US
Practice Address - Phone:281-838-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87755TOtherBCBS