Provider Demographics
NPI:1023336591
Name:ROTHWELL, STACEY MARIE
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARIE
Last Name:ROTHWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3830 NE 79TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-1278
Mailing Address - Country:US
Mailing Address - Phone:816-582-9708
Mailing Address - Fax:
Practice Address - Street 1:9330 LBJ FWY STE 790
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4318
Practice Address - Country:US
Practice Address - Phone:214-575-2999
Practice Address - Fax:214-575-2727
Is Sole Proprietor?:No
Enumeration Date:2010-05-09
Last Update Date:2010-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist