Provider Demographics
NPI:1699895516
Name:WOOLLEY, STACEY RYAN (SLP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:RYAN
Last Name:WOOLLEY
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:RYAN
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1110 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-7425
Mailing Address - Country:US
Mailing Address - Phone:580-380-1885
Mailing Address - Fax:918-894-4431
Practice Address - Street 1:1110 E 20TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-7425
Practice Address - Country:US
Practice Address - Phone:580-380-1885
Practice Address - Fax:918-894-4431
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist