Healthcare Provider Details

I. General information

NPI: 1336384023
Provider Name (Legal Business Name): STACIE L PRESSER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 OLENTANGY RIVER RD
COLUMBUS OH
43212-3135
US

IV. Provider business mailing address

5350 FRANTZ RD
DUBLIN OH
43016-4259
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4710
  • Fax: 614-566-6846
Mailing address:
  • Phone: 614-544-6356
  • Fax: 614-544-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI-4063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: