Provider Demographics
NPI:1285843052
Name:HAUSER, STACEY LYNN (MA, ATR)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:HAUSER
Suffix:
Gender:F
Credentials:MA, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 ELDON DR NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1341
Mailing Address - Country:US
Mailing Address - Phone:330-647-8535
Mailing Address - Fax:
Practice Address - Street 1:4877 GALAXY PKWY STE A
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5952
Practice Address - Country:US
Practice Address - Phone:216-378-5050
Practice Address - Fax:216-378-5060
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist