Provider Demographics
NPI:1811737836
Name:ALCANTAR, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ALCANTAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16001 DARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7350
Mailing Address - Country:US
Mailing Address - Phone:915-222-9453
Mailing Address - Fax:
Practice Address - Street 1:1 W ELLIOT RD STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1310
Practice Address - Country:US
Practice Address - Phone:480-374-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist