Provider Demographics
NPI:1992065734
Name:HARRIS, STACY PEARSON (MA,CCC/SLP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:PEARSON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BENSON DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-1852
Mailing Address - Country:US
Mailing Address - Phone:704-473-3503
Mailing Address - Fax:
Practice Address - Street 1:2830 16TH ST NE APT 138
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-8611
Practice Address - Country:US
Practice Address - Phone:704-473-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist