Individual
MRS. STACY CLARK NISHIBUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.E, IECE
Contact information
Practice address
400 CHAPMAN ST, FRANKLIN, KY 42134-1647
(270) 535-2928
Mailing address
400 CHAPMAN ST, FRANKLIN, KY 42134-1647
(270) 535-2928
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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