Healthcare Provider Details

I. General information

NPI: 1285843052
Provider Name (Legal Business Name): STACEY LYNN HAUSER MA, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4877 GALAXY PKWY STE A
CLEVELAND OH
44128-5952
US

IV. Provider business mailing address

179 ELDON DR NW
WARREN OH
44483-1341
US

V. Phone/Fax

Practice location:
  • Phone: 216-378-5050
  • Fax: 216-378-5060
Mailing address:
  • Phone: 330-647-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: