Provider Demographics
NPI:1881255214
Name:MCGUIRE, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:SILVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1389 WEBER INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6468
Mailing Address - Country:US
Mailing Address - Phone:770-886-6204
Mailing Address - Fax:
Practice Address - Street 1:1389 WEBER INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6468
Practice Address - Country:US
Practice Address - Phone:770-886-6204
Practice Address - Fax:678-261-6421
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCE002850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPCE002850OtherGEORGIA LICENSE