Provider Demographics
NPI:1881930063
Name:DAVIS, STACEY JEAN (MS/CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:JEAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2927
Mailing Address - Country:US
Mailing Address - Phone:425-385-5254
Mailing Address - Fax:
Practice Address - Street 1:4730 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2927
Practice Address - Country:US
Practice Address - Phone:425-385-5259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12044447OtherASHA CCC SLP