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General NPI Number Information
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NPI Number | 1144801796
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Entity Type | Individual
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Provider Name | VIVIAN STAMBAUGH
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Gender | Female
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 2345 E STATE ROAD 14
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City | SILVER LAKE
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State | IN
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Zip | 46982-8817
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Country | US
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Telephone | 260-839-0308
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 E STATE ROAD 14
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City | SILVER LAKE
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State | IN
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Zip | 46982-8817
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Country | US
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Telephone | 260-557-3805
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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