Individual
STACEY WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH. D., CCC-SLP
Contact information
Practice address
3201 ROCKPORT DR, LITHONIA, GA 30038-1834
(954) 415-4069
Mailing address
2209 DISCOVERY CIR W, DEERFIELD BEACH, FL 33442-1006
(954) 415-4069
(954) 596-0355
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
SA5662
FL
235Z00000X
Speech-Language Pathologist
Primary
SLP006932
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003121866B
—
GA
05
—
8857075
—
FL
01
—
SA5662
STATE LICENSE NUMBER
FL
01
—
SLP006932
GA LICENSE NUMBER
GA
Enumeration date
08/18/2006
Last updated
04/08/2014
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us