Individual
MRS. STACY ANN THACKER-NEWSOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LBD
Contact information
Practice address
15903 STATE ROAD 60, BORDEN, IN 47106-8629
(606) 831-1020
Mailing address
15903 STATE ROAD 60, BORDEN, IN 47106-8629
(606) 831-1020
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/19/2015
Last updated
08/19/2015
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