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General NPI Number Information
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NPI Number | 1528171055
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Entity Type | Individual
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Provider Name | STACIE ROST L.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1917 BONO RD
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City | NEW ALBANY
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State | IN
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Zip | 47150-4607
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Country | US
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Telephone | 812-944-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 4452 ERIN DR
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City | FLOYDS KNOBS
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State | IN
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Zip | 47119-9372
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Country | US
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Telephone | 812-923-9451
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33002830A
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License Number State | IN
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