Provider Demographics
NPI:1881040103
Name:SALYER, STACEY RENEE
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:RENEE
Last Name:SALYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 LONGLEAF FOREST LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6896
Mailing Address - Country:US
Mailing Address - Phone:904-900-9689
Mailing Address - Fax:
Practice Address - Street 1:2102 WYNDHAM RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5369
Practice Address - Country:US
Practice Address - Phone:904-349-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL315796906690103K00000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst