Provider Demographics
NPI:1063610483
Name:GEORGE, STACY MARIE (MS, SLP)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 WOODLAND HILLS DR W
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-7491
Mailing Address - Country:US
Mailing Address - Phone:251-645-2392
Mailing Address - Fax:
Practice Address - Street 1:404 WEST WILLOW RD
Practice Address - Street 2:
Practice Address - City:DALE
Practice Address - State:IN
Practice Address - Zip Code:47523
Practice Address - Country:US
Practice Address - Phone:812-937-4489
Practice Address - Fax:812-937-2260
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001709A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist