Lakeside Therapy Group

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP 0710 Issued in WV

Legal business name

LAKESIDE THERAPY GROUP

Practice address

765 Brightridge Drive
Bridgeport, WV 26330

Phone

(304) 844-0099

Fax

(304) 848-0265

NPI assigned

Jun 11, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Stacy Elizabeth Bastin, MA CCC SLPNPI 1174727283

Title

Member Speech Therapist

Phone

(304) 844-0099

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacy Elizabeth Bastin, MA CCC SLP

  • Speech-Language Pathologist
  • Bridgeport, WV
  • NPI 1174727283
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033312574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 BRIGHTRIDGE DRIVE",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "26330",
            "telephone_number": "304-844-0099",
            "fax_number": "304-848-0265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 BRIGHTRIDGE DRIVE",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "26330",
            "telephone_number": "304-844-0099",
            "fax_number": "304-848-0265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE THERAPY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BASTIN",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "MEMBER  SPEECH THERAPIST",
        "authorized_official_telephone_number": "304-844-0099",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA CCC SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WV",
            "license": "SLP 0710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Lynn Kyle
• Jason Edward Labenne, DC
• Laboratory Corporation of America Holdings
• Jeannine Marie Lafferty, MS CCCSLP
• Leslie Lagowski
• Kendall Brooke Lambert, APRN, FNP-BC
• Amy Elizabeth Lamm
• Rachel Lamm
• Gretchen Lantz, PA-C
• Clara Renee Larew, MSN, APRN, FNP-C

• Speech-Language Pathologist in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Speech-Language Pathologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.