Individual
STACY SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21225 LORAIN RD, FAIRVIEW PARK, OH 44126-2120
(440) 331-3180
Mailing address
21225 LORAIN RD, FAIRVIEW PARK, OH 44126-2120
(440) 331-3180
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT 002032
OH
Other
Enumeration date
12/11/2006
Last updated
10/01/2013
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