Provider Demographics
NPI:1649030578
Name:ELLIOTT, STACEY M (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:M
Last Name:ELLIOTT
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 1:417 STABLEFORD ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-0467
Mailing Address - Country:US
Mailing Address - Phone:214-564-4761
Mailing Address - Fax:
Practice Address - Street 1:417 STABLEFORD ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-0467
Practice Address - Country:US
Practice Address - Phone:214-564-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist