STACEY WALLEN (NPI# 1376657114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376657114 |
| Entity Type | Individual |
| Full Name | STACEY WALLEN |
| Credential | PH. D., CCC-SLP |
| Practice Address |
3201 Rockport Dr Lithonia GA 30038-1834 |
| Mailing Address |
2209 Discovery Cir W Deerfield Beach FL 33442-1006 |
| Practice Telephone | 9544154069 |
| Mailing Telephone | 9544154069 |
| Mailing Fax Number | 9545960355 |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2014-04-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 235Z00000X | Speech-Language Pathologist | SLP006932 | GA | Speech, Language and Hearing Service Providers |
| N | 235Z00000X | Speech-Language Pathologist | SA5662 | FL | Speech, Language and Hearing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | GA LICENSE NUMBER | SLP006932 | 01 |
| FL | STATE LICENSE NUMBER | SA5662 | 01 |
| GA | 003121866B | 05 | |
| FL | 8857075 | 05 |
| Street Address |
3201 ROCKPORT DR |
| City | LITHONIA |
| State | GA |
| Zip Code | 30038-1834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548814825 | Cynthia Thomas | Nurse's Aide | 5021 Chupp Way, Lithonia, GA 30038 | 2019-07-25 |
| 1558812131 | Fresenius Medical Care Redan, LLC | Clinic/Center | 8425 Mall Parkway, Lithonia, GA 30038 | 2016-10-19 |
| 1730637059 | Flora's Loving Hands | Psychologist | 4891 Eagles Ridge Loop, Lithonia, GA 30038 | 2016-09-15 |
| 1679921886 | Mercy Oyerinde | Nurse Practitioner | 4742 Lanten Court., Lithonia, GA 30038 | 2016-05-27 |
| 1982020996 | Dina Rebecca Smith | Counselor | 6474 Gina Agha Circle, Lithonia, GA 30038 | 2014-03-14 |
| 1164765889 | Kimberly A Weems | Home Health | 6694 Brownsmill Ferry Drive, Lithonia, GA 30038 | 2013-04-01 |
| 1073850988 | Pain and Spine Solutions, LLC | Specialist | 3974 Glen Park Drive, Lithonia, GA 30038 | 2013-01-11 |
| 1629337514 | Fozi Ouse Adem | Pharmacist | 3140 Turner Hill Road, Lithonia, GA 30038 | 2012-05-11 |
| 1043579402 | Elizabeth Anne Berlin | Physician Assistant | 8825 Mall Parkway, Suite 150, Lithonia, GA 30038 | 2012-05-04 |
| 1730467911 | From Our Heart To Your Heart Personal Care Home | Custodial Care Facility | 4485 Idlewood Park, Lithonia, GA 30038 | 2011-07-22 |
| Find all providers in zip 30038 | ||||
| Taxonomy Code | 235Z00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Speech-Language Pathologist |
| The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing. |
| Notes: "Scope of Practice in Speech-Language Pathology", American Speech-Language-Hearing Association, 2013. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134687908 | Treva Tai Bibbs-bugg | Speech-Language Pathologist | 3123 Klondike Rd, Lithonia, GA 30038-3409 | 2019-03-11 |
| 1063905297 | La'toya Williams | Speech-Language Pathologist | 2540 Wiggins St Ste E, Lithonia, GA 30058-4312 | 2018-06-12 |
| 1154812261 | Raven Samone Watkins | Speech-Language Pathologist | 2537 Oakleaf Rdg, Lithonia, GA 30058-6638 | 2018-05-24 |
| 1083158521 | Destiny Marie Byrd | Speech-Language Pathologist | 4512 Jackam Ridge Ct, Lithonia, GA 30038-6280 | 2016-12-16 |
| 1962847640 | Stephanie W Garrison | Speech-Language Pathologist | 5929 Trent Walk Dr, Lithonia, GA 30038-1964 | 2013-05-08 |
| 1417213901 | Lenear LLC | Speech-Language Pathologist | 4979 Tadmore Ln, Lithonia, GA 30038-2237 | 2012-04-09 |
| 1619263126 | Tiffani H Monroe | Speech-Language Pathologist | 4315 Palisades Place Dr, Lithonia, GA 30038-6146 | 2011-06-22 |
| 1326352402 | Families Matter Therapies, LLC | Speech-Language Pathologist | 7162 Lone Oak Way, Lithonia, GA 30058-8291 | 2010-08-02 |
| 1700022829 | Speech Therepeze | Speech-Language Pathologist | 5784 Fairington Farms Ct, Lithonia, GA 30038-1551 | 2008-12-18 |
| 1376747428 | Tawny Crystal Small-burnam | Speech-Language Pathologist | 6886 Main St Ste 1b2, Box 4, Lithonia, GA 30058-4508 | 2007-06-13 |
| Find all providers in LITHONIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.