Stacy Elizabeth Bastin, MA CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP 0710 Issued in WV

Practice address

765 Brightridge Dr
Bridgeport, WV 26330-1172

Phone

(304) 844-0099

Fax

(304) 848-0265

NPI assigned

Jun 13, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Stacy Elizabeth Drake Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakeside Therapy Group

  • Speech-Language Pathologist
  • Bridgeport, WV
  • NPI 1033312574
  NPD (past) Authorized official

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1174727283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 BRIGHTRIDGE DR",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301172",
            "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 DR",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301172",
            "telephone_number": "304-844-0099",
            "fax_number": "304-848-0265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIN",
        "first_name": "STACY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "MA CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WV",
            "license": "SLP 0710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "DRAKE",
            "middle_name": "ELIZABETH",
            "prefix": "MISS",
            "credential": "MA CCC SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John William Barnes II, O.D.
• Taylor Morgan Barnett, FNP-C
• Teresa Ann Barnett, MS, CCC-SLP
• Madison Leigh Barry, LPC
• Skylar Brooke Bartlett
• Taylor K Bates, BA
• Jehidy Batista Michelena, MD
• Deanne M Bauriedl
• Sara Catherine Bealko, M.S., CCC-SLP
• Adrienne A Bean, PSYD

• 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 Jul 9, 2007; 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.