Provider Demographics
NPI:1477869717
Name:BENNETT, STACY SHELTON (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:SHELTON
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:511 GENTRY LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8857
Mailing Address - Country:US
Mailing Address - Phone:859-209-0944
Mailing Address - Fax:919-294-4500
Practice Address - Street 1:10608 MOUNTAIN LAUREL WAY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-9077
Practice Address - Country:US
Practice Address - Phone:859-209-0944
Practice Address - Fax:919-294-4500
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15093235Z00000X
KY4139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist