Individual
MRS. STACY SHANETTE SALJOUGHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA IN KINESIOLOGY
Contact information
Practice address
921 CRAWFORD ST APT 4106, FORT WORTH, TX 76104-3481
(817) 891-2471
Mailing address
136 FLYAWAY LN, FORT WORTH, TX 76120-1634
(817) 891-2471
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
05/19/2023
Last updated
06/19/2025
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