Stacie J Ellison, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP0355 Issued in AZ

Practice address

10609 W. Willowbrook Dr
Sun City, AZ 85373-6528

Phone

(623) 698-6311

NPI assigned

May 16, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550188800000",
    "number": "1598717050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10609 W. WILLOWBROOK DR",
            "city": "SUN CITY",
            "state": "AZ",
            "postal_code": "853736528",
            "telephone_number": "623-698-6311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10609 W. WILLOWBROOK DR",
            "city": "SUN CITY",
            "state": "AZ",
            "postal_code": "853736528",
            "telephone_number": "623-698-6311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12740 W Indian School Rd",
            "address_2": "#FF116",
            "address_purpose": "LOCATION",
            "city": "Litchfield Park",
            "state": "AZ",
            "postal_code": "853406528",
            "country_code": "US",
            "telephone_number": "623-570-1330",
            "fax_number": "623-218-6229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "STACIE",
        "middle_name": "J",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2019-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP0355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Sun City, AZ
• Providers in Sun City, AZ by specialty
• Speech-Language Pathologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.