Provider Demographics
NPI:1407526882
Name:STACY, RHIANNON NICOLE (CCAR)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:NICOLE
Last Name:STACY
Suffix:
Gender:F
Credentials:CCAR
Other - Prefix:
Other - First Name:RHIANNON
Other - Middle Name:NICOLE
Other - Last Name:HOUGHTELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCAR
Mailing Address - Street 1:1375 S CLARE AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-9442
Mailing Address - Country:US
Mailing Address - Phone:989-386-6622
Mailing Address - Fax:
Practice Address - Street 1:1375 S CLARE AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-9442
Practice Address - Country:US
Practice Address - Phone:989-386-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist