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General NPI Number Information
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NPI Number | 1164242590
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Entity Type | Individual
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Provider Name | STACEY VAN ECK M.ED., ED.S.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 2720 CALIFORNIA RD
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City | ELKHART
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State | IN
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Zip | 46514-1220
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Country | US
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Telephone | 574-262-5542
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Fax |
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Provider Business Mailing Address
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Address Line | 3829 FOX CROSSING DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9150
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Country | US
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Telephone | 269-718-9198
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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