Doctor Name: | STACEY DELFORGE |
NPI Number: | 1366717233 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1708154 |
Business Practice Address: | 337 Main St Birnamwood, WI - 544149259 |
Business Phone Number: | 7154492576 |
Business Fax Number: | |
Mailing Address: | P1561 Old Lake Rd, BIRNAMWOOD |
State: | WI |
Postal Code: | 544149418 |
Phone Number: | 7154493362 |
Fax Number: | |
NPI Enumeration Date: | 03/12/2012 |
NPI Last Update Date: | 03/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 1708154 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
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 |