Provider Demographics
NPI:1982937363
Name:MOORE, STACI L (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:L
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 E MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-1695
Mailing Address - Country:US
Mailing Address - Phone:816-540-3161
Mailing Address - Fax:816-540-5135
Practice Address - Street 1:304 EKLUND ST
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-1041
Practice Address - Country:US
Practice Address - Phone:816-540-2119
Practice Address - Fax:816-540-5135
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist