Individual
MRS. STACEY CARROLL BURTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PLE
Contact information
Practice address
801 HAIL KNOB RD, SOMERSET, KY 42503-3419
(606) 219-0832
Mailing address
801 HAIL KNOB RD, SOMERSET, KY 42503-3419
(606) 219-0832
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/22/2008
Last updated
01/16/2019
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