Stacy Gayle Fuqua
Individual provider Active NPI Speech-Language Pathologist · Perry, MO
NPI 1992869788 · NPPES record last updated Sep 13, 2026
Key facts
- NPI
- 1992869788
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 00963 (MO)
- Practice address
- 208 S Richards St
Perry, MO 63462-1428 - Phone
- (573) 565-3105
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 00963 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 00963 | MO | Yes |
Addresses
Primary practice location
208 S Richards St
Perry, MO 63462-1428
Mailing address
208 S Richards St
Perry, MO 63462-1428
Phone (573) 565-3105
Other providers in Perry, MO
All providers in Perry, 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 Sep 13, 2026. 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.