Provider Demographics
NPI:1689288474
Name:WEADICK, STACY LYN (MA)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYN
Last Name:WEADICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N EMERSON AVE STE 650
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-5522
Mailing Address - Country:US
Mailing Address - Phone:317-752-0763
Mailing Address - Fax:
Practice Address - Street 1:48 N EMERSON AVE STE 650
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-5522
Practice Address - Country:US
Practice Address - Phone:317-752-0763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health