Provider Demographics
NPI:1861931040
Name:BARRETT, STASIA (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STASIA
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1952
Mailing Address - Country:US
Mailing Address - Phone:301-541-3277
Mailing Address - Fax:
Practice Address - Street 1:4209 NEWTON ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-1952
Practice Address - Country:US
Practice Address - Phone:301-541-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist