Doctor Name: | MRS. STACEY RENAE NICKELL |
NPI Number: | 1225372667 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC-SLP |
License Number: | SLP-1137 |
Business Practice Address: | 405 Stanaford Rd Beckley, WV - 258013143 |
Business Phone Number: | 3042526317 |
Business Fax Number: | |
Mailing Address: | 405 Stanaford Rd, BECKLEY |
State: | WV |
Postal Code: | 258013143 |
Phone Number: | 3042526317 |
Fax Number: | |
NPI Enumeration Date: | 11/26/2012 |
NPI Last Update Date: | 11/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP-1137 |
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 |