Individual
STACY L DEITRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MACCCSLP
Contact information
Practice address
1201 DALY DR, NEW HAVEN, IN 46774-1891
(260) 749-0413
(260) 749-2531
Mailing address
2310 SILVER PALM DR APT 203, KISSIMMEE, FL 34747-2746
(937) 733-6216
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA19289
FL
Other
Enumeration date
05/05/2014
Last updated
10/29/2021
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