| Doctor Name: | STACEY WALLEN |
| NPI Number: | 1376657114 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH. D., CCC-SLP |
| License Number: | SA5662 |
| Business Practice Address: | 3201 Rockport Dr Lithonia, GA - 300381834 |
| Business Phone Number: | 9544154069 |
| Business Fax Number: | |
| Mailing Address: | 2209 Discovery Cir W, DEERFIELD BEACH |
| State: | FL |
| Postal Code: | 334421006 |
| Phone Number: | 9544154069 |
| Fax Number: | 9545960355 |
| NPI Enumeration Date: | 08/18/2006 |
| NPI Last Update Date: | 04/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA5662 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| 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 |