Provider Demographics
NPI:1316271513
Name:POUND, STACEY MICHELE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MICHELE
Last Name:POUND
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 SAGEBRUSH DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7501
Mailing Address - Country:US
Mailing Address - Phone:208-420-2587
Mailing Address - Fax:
Practice Address - Street 1:479 POLK ST
Practice Address - Street 2:SUITE B
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4850
Practice Address - Country:US
Practice Address - Phone:208-733-2661
Practice Address - Fax:208-733-0191
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist