Basic Information
| Provider Information | |||||||||
| NPI: | 1336159532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATCHER | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | LYN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17683 72ND RD N | ||||||||
| Address2: | |||||||||
| City: | LOXAHATCHEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334706101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614227065 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5325 GREENWOOD AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618812822 | ||||||||
| FaxNumber: | 5618810972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 06/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA4304 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 81084700 | 05 | FL | MEDICAID |