Provider Demographics
NPI:1174947667
Name:KUYKENDALL, STACY (AUD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 ANCHOR DR
Mailing Address - Street 2:300-B
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8266
Mailing Address - Country:US
Mailing Address - Phone:409-727-4327
Mailing Address - Fax:409-727-5176
Practice Address - Street 1:7980 ANCHOR DR
Practice Address - Street 2:300-B
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8266
Practice Address - Country:US
Practice Address - Phone:409-727-4327
Practice Address - Fax:409-727-5176
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80487231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist