Provider Demographics
NPI:1063726172
Name:CARRELL, STACIE CHRISTINE (STACIE BATEMAN)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:CHRISTINE
Last Name:CARRELL
Suffix:
Gender:F
Credentials:STACIE BATEMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ORANGE BLOSSOM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4400
Mailing Address - Country:US
Mailing Address - Phone:714-943-4944
Mailing Address - Fax:949-271-4941
Practice Address - Street 1:46 ORANGE BLOSSOM
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4400
Practice Address - Country:US
Practice Address - Phone:714-943-4944
Practice Address - Fax:949-271-4941
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist