Healthcare Provider Details

I. General information

NPI: 1952818916
Provider Name (Legal Business Name): STACY LEE STUDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 DETROIT AVE
CLEVELAND OH
44102-2224
US

IV. Provider business mailing address

11423 E HUFFMAN RD APT 9
PARMA HEIGHTS OH
44130-2229
US

V. Phone/Fax

Practice location:
  • Phone: 216-306-1237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2406438
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: