Provider Demographics
NPI:1760184139
Name:HATCHER, STACY MARIE (BA/BIS)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:HATCHER
Suffix:
Gender:F
Credentials:BA/BIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:COCOLALLA
Mailing Address - State:ID
Mailing Address - Zip Code:83813-0154
Mailing Address - Country:US
Mailing Address - Phone:208-946-8985
Mailing Address - Fax:
Practice Address - Street 1:260 HATCHER ROAD
Practice Address - Street 2:
Practice Address - City:COCOLALLA
Practice Address - State:ID
Practice Address - Zip Code:83813-8381
Practice Address - Country:US
Practice Address - Phone:208-946-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician