Provider Demographics
NPI:1144831504
Name:WEBB, STACIE ANN (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:ANN
Last Name:WEBB
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 1:113 LAHAINA DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4908
Mailing Address - Country:US
Mailing Address - Phone:432-770-2881
Mailing Address - Fax:
Practice Address - Street 1:8050 DR EMMT HEADLEE ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8016
Practice Address - Country:US
Practice Address - Phone:432-847-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24809235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist