Individual
STACIE TUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3751 W MAIN ST, INDEPENDENCE, KS 67301-8446
(620) 331-1748
Mailing address
PO BOX 688, INDEPENDENCE, KS 67301-0688
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW 5921
KS
Other
Enumeration date
01/15/2015
Last updated
01/15/2015
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