Healthcare Provider Details

I. General information

NPI: 1528975331
Provider Name (Legal Business Name): MRS. STACY ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 N STATE ROUTE 589
CASSTOWN OH
45312-9707
US

IV. Provider business mailing address

3825 N STATE ROUTE 589
CASSTOWN OH
45312-9707
US

V. Phone/Fax

Practice location:
  • Phone: 937-335-5439
  • Fax:
Mailing address:
  • Phone: 937-335-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00567
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: