Doctor Name: | MRS. STACY ELIZABETH BASTIN |
NPI Number: | 1174727283 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA CCC SLP |
License Number: | SLP 0710 |
Business Practice Address: | 765 Brightridge Dr Bridgeport, WV - 263301172 |
Business Phone Number: | 3048440099 |
Business Fax Number: | 3048480265 |
Mailing Address: | 765 Brightridge Dr, BRIDGEPORT |
State: | WV |
Postal Code: | 263301172 |
Phone Number: | 3048440099 |
Fax Number: | 3048480265 |
NPI Enumeration Date: | 06/13/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP 0710 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |