Basic Information
| Provider Information | |||||||||
| NPI: | 1891997144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLANAGAN | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MSCCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6396 BRIDGEPORT LN | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334636533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614326417 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2623 S SEACREST BLVD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334357501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617377733 | ||||||||
| FaxNumber: | 5617357036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 2863 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.