Individual
MS. STACY D,ANN FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100E. MAIN ST., MEDFORD, OR 97504
(541) 292-7177
Mailing address
100 E MAIN ST, MEDFORD, OR 97501-6041
(541) 292-7177
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/07/2011
Last updated
01/07/2011
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