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General NPI Number Information
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NPI Number | 1831998798
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Entity Type | Individual
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Provider Name | MS. STACEY A NELSON
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Gender | Female
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 2399 E WALTON BLVD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-1955
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Country | US
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Telephone | 947-226-8315
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Fax | 248-475-6402
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Provider Business Mailing Address
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Address Line | 1235 ARROWWOOD LN
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City | GRAND BLANC
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State | MI
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Zip | 48439-4861
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Country | US
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Telephone | 810-964-9669
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851119588
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License Number State | MI
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