Provider Demographics
NPI:1902274772
Name:DOVER, STACI (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:DOVER
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:PO BOX 30759
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85046-0759
Mailing Address - Country:US
Mailing Address - Phone:480-406-3453
Mailing Address - Fax:602-283-4184
Practice Address - Street 1:1322 E LE MARCHE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3245
Practice Address - Country:US
Practice Address - Phone:602-283-4121
Practice Address - Fax:602-283-4184
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA87602355S0801X
AZSLP8760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP8760OtherARIZONA DEPARTMENT OF HEALTH SERVICES