Active NPI
Stacey L Davis
- Speech-Language Pathologist
- Carbondale, IL
National Provider Identifier
1801924196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146006880
- Practice address
- 2751 W Main Street
Carbondale, IL 62901-1000 - Phone
- (618) 529-5944
- Fax
- (618) 529-5785
- NPI assigned
- Mar 1, 2007
- 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 | 146006880 | IL | Primary |
Addresses
Primary practice location
2751 W Main Street
Carbondale, IL 62901-1000
Mailing address
523 E Park St
Du Quoin, IL 62832-2253
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 |
|---|---|---|---|
| 146006880 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Archway, Inc. | Past | Accepting new patients | |
| Archway, Inc. | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Carbondale, IL
- NPI 1669696399
-
- Speech-Language Pathologist
- Carbondale, IL
- NPI 1720114788
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738713600000",
"number": "1801924196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "523 E PARK ST",
"city": "DU QUOIN",
"state": "IL",
"postal_code": "628322253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2751 W MAIN STREET",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011000",
"telephone_number": "618-529-5944",
"fax_number": "618-529-5785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "STACEY",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2025-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146006880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.