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Individual

STACY GAYLE FUQUA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
208 S RICHARDS ST, PERRY, MO 63462-1428
(573) 565-3105
Mailing address
208 S RICHARDS ST, PERRY, MO 63462-1428
(573) 565-3105

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
00963
MO

Other

Enumeration date
12/19/2006
Last updated
07/08/2007
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