Provider Demographics
NPI:1477188860
Name:HOTH, STACEY (MA, CADC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HOTH
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SOLAR DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-2463
Mailing Address - Country:US
Mailing Address - Phone:319-232-2086
Mailing Address - Fax:
Practice Address - Street 1:1310 SOLAR DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-2463
Practice Address - Country:US
Practice Address - Phone:319-232-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)