Provider Demographics
NPI:1871934935
Name:STAFFORD, MIRIAM (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-1704
Mailing Address - Country:US
Mailing Address - Phone:713-523-4722
Mailing Address - Fax:713-523-8399
Practice Address - Street 1:2474 E JOYCE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4932
Practice Address - Country:US
Practice Address - Phone:479-521-8326
Practice Address - Fax:479-521-5439
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109054235Z00000X
AR200076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist