Provider Demographics
NPI:1902057300
Name:NEWMAN, STACEY NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:NICOLE
Last Name:NEWMAN
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 1:212 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3712
Mailing Address - Country:US
Mailing Address - Phone:816-830-2742
Mailing Address - Fax:
Practice Address - Street 1:212 E 18TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3712
Practice Address - Country:US
Practice Address - Phone:816-830-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029382235Z00000X
KS3652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist