Provider Demographics
NPI:1316227200
Name:SHOEMAKE, STACEYANN WADE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STACEYANN
Middle Name:WADE
Last Name:SHOEMAKE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:STACEYANN
Other - Middle Name:
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2607 HARDWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7583
Mailing Address - Country:US
Mailing Address - Phone:817-821-3397
Mailing Address - Fax:
Practice Address - Street 1:605 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1794
Practice Address - Country:US
Practice Address - Phone:817-299-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist