Provider Demographics
NPI:1831863059
Name:MEADOWS, STACEY (SLP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 COUNTY ROAD 2350 N
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:IL
Mailing Address - Zip Code:62868-9215
Mailing Address - Country:US
Mailing Address - Phone:618-925-2881
Mailing Address - Fax:
Practice Address - Street 1:900 E SCOTT ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2576
Practice Address - Country:US
Practice Address - Phone:618-395-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist