Provider Demographics
NPI:1801290978
Name:PRITCHETT, STACY M (HAD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 E SUNSET RD
Mailing Address - Street 2:UNIT 5-260
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3511
Mailing Address - Country:US
Mailing Address - Phone:702-798-0113
Mailing Address - Fax:866-291-5242
Practice Address - Street 1:2635 SANDY PLAINS RD
Practice Address - Street 2:SUITE A2
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4200
Practice Address - Country:US
Practice Address - Phone:770-509-0207
Practice Address - Fax:770-579-2306
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000889237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist