Provider Demographics
NPI:1255576096
Name:CHILDS, STACIA G (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:G
Last Name:CHILDS
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 1:721 CORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8271
Mailing Address - Country:US
Mailing Address - Phone:816-322-6426
Mailing Address - Fax:
Practice Address - Street 1:7620 METCALF AVE
Practice Address - Street 2:SUITE M
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2928
Practice Address - Country:US
Practice Address - Phone:913-383-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2671235Z00000X
MO2006026271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist