Provider Demographics
NPI:1902274772
Name:MCCAULEY, STACI (MS CF-SLP/L)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:MS CF-SLP/L
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 5630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011
Mailing Address - Country:US
Mailing Address - Phone:928-523-6759
Mailing Address - Fax:928-523-4953
Practice Address - Street 1:912 RIORDAN RANCH RD
Practice Address - Street 2:BLDG 27A RM 171
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011
Practice Address - Country:US
Practice Address - Phone:928-523-6759
Practice Address - Fax:928-523-4953
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2018-10-16
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
AZSLP8760OtherAZ TEMP SLP INITIAL LICENSE