Provider Demographics
NPI:1730344250
Name:LECOURS, STACEY LYNNE (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNNE
Last Name:LECOURS
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 1:1225 WORDENS POND RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3738
Mailing Address - Country:US
Mailing Address - Phone:401-782-4709
Mailing Address - Fax:
Practice Address - Street 1:1225 WORDENS POND RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-3738
Practice Address - Country:US
Practice Address - Phone:401-782-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist