Stacey A Burton
Individual provider Active NPI Speech-Language Pathologist · Republic, MO
NPI 1467662965 · NPPES record last updated Feb 23, 2009
Key facts
- NPI
- 1467662965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 118464 (MO)
- Practice address
- Republic R-III
518 N Hampton Ave
Republic, MO 65738-1323 - Phone
- (417) 732-3609
- Fax
- (417) 732-3605
- NPI assigned
- May 23, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118464 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 118464 | MO | Yes |
Addresses
Primary practice location
Republic R-III
518 N Hampton Ave
Republic, MO 65738-1323
Mailing address
518 N Hampton Ave
Republic, MO 65738-1323
Phone (417) 732-3609
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 465697613 | Medicaid | MO |
Other providers in Republic, MO
- Scott Brueckner
- David Kent Budd
- Hannah Bumgarner
- Lucas Austin Burbridge
- Mary M. Burch
- Kara J Cain
- Andrew Cameron
- Sara Carmichael
- Blaine Alan Carter
- Erin Elizabeth Casey
All providers in Republic, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.