Individual
SUSAN STAHLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 RED COACH DR, MISHAWAKA, IN 46545-8307
(574) 345-0046
Mailing address
215 RED COACH DR, MISHAWAKA, IN 46545-8307
(574) 345-0046
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-24-72228
IN
235Z00000X
Speech-Language Pathologist
Primary
22005317A
IN
Other
Enumeration date
02/02/2012
Last updated
11/03/2025
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