Provider Demographics
NPI:1003432972
Name:KLUSMEIER, STACY R (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:R
Last Name:KLUSMEIER
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 VALLEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-8938
Mailing Address - Country:US
Mailing Address - Phone:573-450-0076
Mailing Address - Fax:
Practice Address - Street 1:2809 VALLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-8938
Practice Address - Country:US
Practice Address - Phone:573-450-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-19-37351103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst