Provider Demographics
NPI:1992276984
Name:WARNER, STACIE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:WARNER
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 1:15474 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:17214-9738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 CLARKE PL
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6529
Practice Address - Country:US
Practice Address - Phone:301-360-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist