Provider Demographics
NPI:1114630647
Name:NEAULT, STACY L (CPRS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:NEAULT
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 OLD SCIOTO TRL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-6642
Mailing Address - Country:US
Mailing Address - Phone:740-351-9298
Mailing Address - Fax:740-529-0553
Practice Address - Street 1:4300 OLD SCIOTO TRL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-6642
Practice Address - Country:US
Practice Address - Phone:740-351-9298
Practice Address - Fax:740-529-0553
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.002771175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist