Provider Demographics
NPI:1386132991
Name:LABEFF, STACY M (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:M
Last Name:LABEFF
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 1:921 SHILOH RD STE C120
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1407
Mailing Address - Country:US
Mailing Address - Phone:903-939-2800
Mailing Address - Fax:866-386-4531
Practice Address - Street 1:921 SHILOH RD STE C120
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1407
Practice Address - Country:US
Practice Address - Phone:903-939-2800
Practice Address - Fax:866-386-4531
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist