Healthcare Provider Details

I. General information

NPI: 1083529903
Provider Name (Legal Business Name): STACY MICHELLE GREENWOOD ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 SW 29TH ST
TOPEKA KS
66614-4700
US

IV. Provider business mailing address

2416 ALISTER DR
LAWRENCE KS
66049-1888
US

V. Phone/Fax

Practice location:
  • Phone: 785-339-4936
  • Fax:
Mailing address:
  • Phone: 785-339-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number9825437146
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: