Provider Demographics
NPI:1699460626
Name:ORR, STACY LYNN (AAS, SLP-A)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:ORR
Suffix:
Gender:F
Credentials:AAS, SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38201 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:TONOPAH
Mailing Address - State:AZ
Mailing Address - Zip Code:85354-8671
Mailing Address - Country:US
Mailing Address - Phone:623-474-5568
Mailing Address - Fax:
Practice Address - Street 1:30919 W WHITE TANK VIS
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-4656
Practice Address - Country:US
Practice Address - Phone:623-474-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA142832355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant