Provider Demographics
NPI:1538242276
Name:KAMMER, STACIE (SLP)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:KAMMER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9939 DETLING RD
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:OH
Mailing Address - Zip Code:45303-9736
Mailing Address - Country:US
Mailing Address - Phone:937-548-9495
Mailing Address - Fax:937-548-3055
Practice Address - Street 1:1101 JACKSON ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1396
Practice Address - Country:US
Practice Address - Phone:937-547-2319
Practice Address - Fax:937-548-4248
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OHSP.07455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist