Provider Demographics
NPI:1053670604
Name:RATLIFF, STACI LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:LYNN
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPRING BANK DR
Mailing Address - Street 2:STE 1
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7553
Mailing Address - Country:US
Mailing Address - Phone:270-240-1076
Mailing Address - Fax:270-906-1150
Practice Address - Street 1:1401 SPRING BANK DR
Practice Address - Street 2:STE 1
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7553
Practice Address - Country:US
Practice Address - Phone:270-240-1076
Practice Address - Fax:270-906-1150
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50401041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK127633Medicare PIN