Mathis, Stacey Leigh
Mathis, Stacey Leigh is an individual health care provider with primary practice located at 5600 Goodman Rd Ste D , Olive Branch MS 38654-7002. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Mathis, Stacey Leigh can be contacted via phone (662) 895-4545.Contact Information
Primary practice address
5600 Goodman Rd Ste D
Olive Branch MS 38654-7002
Phone: (662) 895-4545
Fax: (662) 895-4546
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | S2304 | Mississippi |
Profile Details
| NPI number | 1023039906 |
|---|---|
| LBN Legal business name | Mathis, Stacey Leigh |
| Credentials | MS,CCC-SLP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 23rd, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023039906 | NPPES |
| Mississippi | MEDICAID | 09877809 |
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