# STACEY L BOLES

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1497927461
- **Gender:** F
- **Credential:** M.S., CCC-A

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 23002258A | IN | Yes |
| 237600000X | Audiologist-Hearing Aid Fitter | 23002258A | IN | — |

## Other

- **Enumeration date:** 03/30/2008
- **Last updated:** 02/28/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | P01027070 | MEDICARE RR PTAN | IN |