1184702029 NPI number — MRS. STACEY LYNNETTE WOODS M.A., CCC-A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184702029 NPI number — MRS. STACEY LYNNETTE WOODS M.A., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
STACEY
Provider Middle Name:
LYNNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184702029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 N GRAND AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FORT THOMAS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41075-4107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-781-4900
Provider Business Mailing Address Fax Number:
859-572-3044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
SUITE 268
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-344-4442
Provider Business Practice Location Address Fax Number:
859-344-4443
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  0323 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 0729 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 0323 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KY0323 . This is a "KY PATHOLOGY/AUDIOLOGIST" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 23002176A . This is a "IN AUDIOGOLIST" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: KY 0729 . This is a "KY SPEC. HEARING INSTRUME" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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