Healthcare Provider Details

I. General information

NPI: 1558286559
Provider Name (Legal Business Name): ELIZABETH STALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EDUCATION DR
WEST ALEXANDRIA OH
45381-1184
US

IV. Provider business mailing address

827 WYATT RD
EATON OH
45320-9555
US

V. Phone/Fax

Practice location:
  • Phone: 937-839-4688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: