Provider Demographics
NPI:1265815930
Name:HAUCK, STACEY (LMSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HAUCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21350 W 153RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5413
Mailing Address - Country:US
Mailing Address - Phone:913-322-4900
Mailing Address - Fax:913-780-1284
Practice Address - Street 1:21344 WEST 153RD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5413
Practice Address - Country:US
Practice Address - Phone:913-499-8100
Practice Address - Fax:913-499-8111
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS96561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical