Individual
MRS. MICHELLE LOIS STACKHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PEER SUPPORT
Contact information
Practice address
5736 EAST BLVD NW, CANTON, OH 44718-1655
(330) 806-1953
Mailing address
5736 EAST BLVD NW, CANTON, OH 44718-1655
(330) 806-1953
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
00030
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34-1575839
ICAN, INC.
OH
Enumeration date
09/19/2018
Last updated
09/19/2018
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