Provider Demographics
NPI:1871766063
Name:STACY, MICHELLE HAND (SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:HAND
Last Name:STACY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-7998
Mailing Address - Country:US
Mailing Address - Phone:479-872-1603
Mailing Address - Fax:
Practice Address - Street 1:4337 GRIMSLEY RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-8448
Practice Address - Country:US
Practice Address - Phone:479-750-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist