Stacey Childers, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA15876 Issued in FL

Practice address

4200 Purdy LN
Palm Springs, FL 33461-1469

Phone

(561) 804-3500

NPI assigned

Dec 7, 2017

Last updated

Jan 17, 2020By 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

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": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579219200000",
    "number": "1639684087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11606 FICUS ST",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334102618",
            "telephone_number": "913-634-3221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 PURDY LN",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334611469",
            "telephone_number": "561-804-3500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12785 Forest Hill Blvd",
            "address_2": "#8g",
            "address_purpose": "LOCATION",
            "city": "Wellington",
            "state": "FL",
            "postal_code": "33414",
            "country_code": "US",
            "telephone_number": "561-753-4998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHILDERS",
        "first_name": "STACEY",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-07",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA15876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Palm Springs, FL
• Providers in Palm Springs, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; 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.