Provider Demographics
NPI:1184702029
Name:WOODS, STACEY LYNNETTE (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNNETTE
Last Name:WOODS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
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Mailing Address - Street 1:40 N GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4107
Mailing Address - Country:US
Mailing Address - Phone:859-781-4900
Mailing Address - Fax:859-572-3044
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:SUITE 268
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-344-4442
Practice Address - Fax:859-344-4443
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY0323235Z00000X, 231H00000X
KY0729237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY0323OtherKY PATHOLOGY/AUDIOLOGIST
IN23002176AOtherIN AUDIOGOLIST
KYKY 0729OtherKY SPEC. HEARING INSTRUME