Provider Demographics
NPI:1881163368
Name:WIBLE, STACIE LYNN (MA)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:WIBLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 ROUTE 33 STE 12
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-2727
Mailing Address - Country:US
Mailing Address - Phone:609-222-3957
Mailing Address - Fax:725-201-4863
Practice Address - Street 1:34 MOHAWK TRAIL
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016
Practice Address - Country:US
Practice Address - Phone:609-222-3957
Practice Address - Fax:725-201-4863
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty