Provider Demographics
NPI:1952991085
Name:KAUFFMAN, STACEY LYNN (SLPA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:SEABERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16450 W VAN BUREN ST APT 2048
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1611
Mailing Address - Country:US
Mailing Address - Phone:717-917-0923
Mailing Address - Fax:
Practice Address - Street 1:16450 W VAN BUREN ST APT 2048
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1611
Practice Address - Country:US
Practice Address - Phone:717-917-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA127632355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant