Provider Demographics
NPI:1972861946
Name:HEADD, STACY DENISE (MSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:DENISE
Last Name:HEADD
Suffix:
Gender:F
Credentials:MSW
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 172033
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66117-1033
Mailing Address - Country:US
Mailing Address - Phone:913-219-8796
Mailing Address - Fax:816-734-1485
Practice Address - Street 1:2845 N 39TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-2504
Practice Address - Country:US
Practice Address - Phone:913-219-8796
Practice Address - Fax:816-734-1485
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator