Individual
STACEY R GEDEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
9249 W LAKE CITY RD, HOUGHTON LAKE, MI 48629-9602
(989) 422-5122
(989) 422-4378
Mailing address
9249 W LAKE CITY RD, HOUGHTON LAKE, MI 48629-9602
(989) 422-5122
(989) 422-4378
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301010429
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G27604070
MEDICARE PTAN
MI
Enumeration date
07/09/2006
Last updated
10/15/2016
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