Provider Demographics
NPI:1336159532
Name:HATCHER, STACY LYN (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYN
Last Name:HATCHER
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 1:17683 72ND RD N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-6101
Mailing Address - Country:US
Mailing Address - Phone:561-422-7065
Mailing Address - Fax:
Practice Address - Street 1:5325 GREENWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2452
Practice Address - Country:US
Practice Address - Phone:561-881-2822
Practice Address - Fax:561-881-0972
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81084700Medicaid