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General NPI Number Information
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NPI Number | 1336274968
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Entity Type | Individual
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Provider Name | STACEY A. ANDERSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 11311 S STEPHANIE DR
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City | YUMA
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State | AZ
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Zip | 85367-5862
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Country | US
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Telephone | 928-287-5901
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Fax | 928-342-1331
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Provider Business Mailing Address
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Address Line | 11311 S STEPHANIE DR
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City | YUMA
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State | AZ
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Zip | 85367-5862
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Country | US
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Telephone | 928-287-5901
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Fax | 928-342-1331
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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 | AZ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4068
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License Number State | AZ
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