Provider Demographics
NPI:1952346272
Name:DEVRIES, STACEY L (MS-CCC, SLP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:L
Last Name:DEVRIES
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 1:5358 PEERLESS PLACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WADMALAW ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29487
Mailing Address - Country:US
Mailing Address - Phone:843-263-1813
Mailing Address - Fax:
Practice Address - Street 1:5358 PEERLESS PLACE DR
Practice Address - Street 2:
Practice Address - City:WADMALAW ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29487-7119
Practice Address - Country:US
Practice Address - Phone:843-263-1813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist