Individual
MISS STACEY LEANN PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19 16TH ST, MCMECHEN, WV 26040-1321
(304) 517-6481
Mailing address
19 16TH ST, MCMECHEN, WV 26040-1321
(304) 517-6481
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
07/20/2022
Last updated
07/20/2022
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