Active NPI
Stacey S Dennard, SLP
- Speech-Language Pathologist
- Caddo Mills, TX
National Provider Identifier
1346308269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 14892
- Practice address
- 2505 First St
Caddo Mills, TX 75135-6822 - Phone
- (903) 527-8115
- NPI assigned
- Dec 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 14892 | TX | Primary |
Addresses
Primary practice location
2505 First St
Caddo Mills, TX 75135-6822
Mailing address
2505 First St
Caddo Mills, TX 75135-6822
Phone (903) 527-8115
Other practice location 1
4804 Wesley ST
Greenville, TX 75401
Phone (903) 454-0300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A023 | Other | TX | TRICARE NUMBER |
| 005783802 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14892 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657065600000",
"number": "1346308269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2505 FIRST ST",
"city": "CADDO MILLS",
"state": "TX",
"postal_code": "751356822",
"telephone_number": "903-527-8115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2505 FIRST ST",
"city": "CADDO MILLS",
"state": "TX",
"postal_code": "751356822",
"telephone_number": "903-527-8115"
}
],
"practiceLocations": [
{
"address_1": "4804 Wesley ST",
"address_purpose": "LOCATION",
"city": "Greenville",
"state": "TX",
"postal_code": "75401",
"country_code": "US",
"telephone_number": "903-454-0300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DENNARD",
"first_name": "STACEY",
"middle_name": "S",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-04",
"last_updated": "2022-07-06",
"certification_date": "2022-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "14892",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE NUMBER",
"identifier": "A023",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "005783802",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Caddo Mills, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.