Individual
STACEY RENEE SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13 TERRY CT, DOUGLASSVILLE, PA 19518-1534
(484) 300-0708
Mailing address
13 TERRY CT, DOUGLASSVILLE, PA 19518-1534
(484) 300-0708
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH005362
PA
Other
Enumeration date
07/16/2021
Last updated
09/13/2021
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