Provider Demographics
NPI:1598483133
Name:HENRY, STACI MONTGOMERY
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:MONTGOMERY
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-0309
Mailing Address - Country:US
Mailing Address - Phone:337-783-3668
Mailing Address - Fax:337-783-3761
Practice Address - Street 1:2122 N PARKERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2001
Practice Address - Country:US
Practice Address - Phone:337-783-3668
Practice Address - Fax:337-783-1232
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45642355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant