Provider Demographics
NPI:1104065309
Name:TRAINOR, STACY JORDAN (SLP)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:JORDAN
Last Name:TRAINOR
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:JORDAN
Other - Last Name:HOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1226 W OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3618
Mailing Address - Country:US
Mailing Address - Phone:602-707-8604
Mailing Address - Fax:602-707-2640
Practice Address - Street 1:1226 W OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3618
Practice Address - Country:US
Practice Address - Phone:602-707-8604
Practice Address - Fax:602-707-2040
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist