Provider Demographics
NPI:1063536936
Name:HENN, STACY RAE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:RAE
Last Name:HENN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21609 W 98TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-2686
Mailing Address - Country:US
Mailing Address - Phone:913-638-9617
Mailing Address - Fax:
Practice Address - Street 1:21609 W 98TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220-2686
Practice Address - Country:US
Practice Address - Phone:913-638-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist