Provider Demographics
NPI:1053729657
Name:HITTLE, STACEY LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LEIGH
Last Name:HITTLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:LEIGH
Other - Last Name:KRONMUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:600 NE MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1983
Mailing Address - Country:US
Mailing Address - Phone:816-554-9866
Mailing Address - Fax:
Practice Address - Street 1:600 NE MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1983
Practice Address - Country:US
Practice Address - Phone:816-554-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015432235Z00000X
KS3103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist