Individual
SAMANTHA MORGAN STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 S FRANCES ST, SOUTH BEND, IN 46617-3120
(574) 217-1624
Mailing address
6910 N MAIN ST UNIT 13C, GRANGER, IN 46530-9681
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
99097145A
IN
Other
Enumeration date
02/04/2020
Last updated
02/04/2020
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