Individual
STACEY CLEVENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
369 W CASS ST, CICERO, IN 46034-5029
(614) 378-3359
Mailing address
PO BOX 931, CICERO, IN 46034-0931
(614) 378-3359
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT21906856
IN
Other
Enumeration date
07/22/2021
Last updated
07/22/2021
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