Provider Demographics
NPI:1417215096
Name:HAWLEY, STACY LEROY (BSHS)
Entity Type:Individual
Prefix:MR
First Name:STACY
Middle Name:LEROY
Last Name:HAWLEY
Suffix:
Gender:M
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11652 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-8465
Mailing Address - Country:US
Mailing Address - Phone:616-248-5143
Mailing Address - Fax:616-897-5954
Practice Address - Street 1:11652 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8465
Practice Address - Country:US
Practice Address - Phone:616-248-5143
Practice Address - Fax:616-897-5954
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker