Wallen, Stacey

Wallen, Stacey is an sole proprietor health care provider with primary practice located at 3201 Rockport Dr , Lithonia GA 30038-1834. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Wallen, Stacey can be contacted via phone (954) 415-4069.

Contact Information

Primary practice address
3201 Rockport Dr Lithonia GA 30038-1834
Phone: (954) 415-4069
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X SA5662 Florida
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X SLP006932 Georgia

Profile Details

NPI number 1376657114
LBN Legal business name Wallen, Stacey
Credentials PH. D., CCC-SLP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 18th, 2006
Last updated Apr 8th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376657114 NPPES
Georgia Other SLP006932 GA LICENSE NUMBER
Georgia Other SA5662 GA LICENSE NUMBER
Georgia MEDICAID 003121866B GA LICENSE NUMBER
Georgia MEDICAID 8857075 GA LICENSE NUMBER

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