Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Stacy Nicole Kisor

Individual provider Speech-Language Pathologist · NPI 1770829061

Mrs. Stacy Nicole Kisor is a Qualified Speech Language Pathologist in Las Vegas, Nevada. Qualified in 2012, 14 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
14
Licensed in
WA
In the registry since
2012
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Practice location Address checks out

5516 S Fort Apache Rd Ste 130
Las Vegas, NV 89148-7679
Phone: (702) 641-8255
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence SI 60298212 (WA)

Record details

NPI number1770829061
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedDecember 14, 2012
Last updated in NPPESFebruary 26, 2020
Certification dateFebruary 26, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyQUALIFIED SPEECH LANGUAGE PATHOLOGIST
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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