Provider Demographics
NPI:1194603902
Name:HATHAWAY, STEFANI (PHD)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29204 TRACY CREEK DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7450
Mailing Address - Country:US
Mailing Address - Phone:419-666-3586
Mailing Address - Fax:
Practice Address - Street 1:29204 TRACY CREEK DR APT 3A
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7450
Practice Address - Country:US
Practice Address - Phone:419-666-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6491103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling