Individual
STACEY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1002 S DILLARD ST STE 106, WINTER GARDEN, FL 34787-3991
(407) 877-0029
(407) 358-5207
Mailing address
93 HILLSIDE DR, EUSTIS, FL 32726-7614
(352) 638-4583
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
03/06/2020
Last updated
03/06/2020
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