Provider Demographics
NPI:1770725079
Name:THOMPSON, STACEY L (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 RESEARCH BLVD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6250
Mailing Address - Country:US
Mailing Address - Phone:301-424-5200
Mailing Address - Fax:301-424-8063
Practice Address - Street 1:2301 RESEARCH BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3204
Practice Address - Country:US
Practice Address - Phone:301-424-5200
Practice Address - Fax:301-424-8063
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist