Stacey Wallen, PH. D., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP006932 Issued in GA

Practice address

3201 Rockport Dr
Lithonia, GA 30038-1834

Phone

(954) 415-4069

NPI assigned

Aug 18, 2006

Last updated

Apr 8, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396915200000",
    "number": "1376657114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 DISCOVERY CIR W",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334421006",
            "telephone_number": "954-415-4069",
            "fax_number": "954-596-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 ROCKPORT DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300381834",
            "telephone_number": "954-415-4069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "STACEY",
        "credential": "PH. D., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2014-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA5662",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP006932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "SA5662",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA LICENSE NUMBER",
            "identifier": "SLP006932",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8857075",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003121866B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Rite Aid #11694)
• .Nadine Victoria Walker, M.D.
• Leenise Walker
• Lila K Walker, PH.D.
• Trudi B Walker, PMHNP-BC
• Aliyah K Walton
• Pamela Dionne Walton, LPC
• Attalla Ward
• Sharon L Washington, RN
• Yolanda Washington

• Speech-Language Pathologist in Lithonia, GA
• Providers in Lithonia, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2014; 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.