Provider Demographics
NPI:1245862416
Name:REICHENBACKER, STACEY (MS, NBC-HWC, CHWC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:REICHENBACKER
Suffix:
Gender:F
Credentials:MS, NBC-HWC, CHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 PINEWAY CT
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-5100
Mailing Address - Country:US
Mailing Address - Phone:812-463-3107
Mailing Address - Fax:
Practice Address - Street 1:604 PINEWAY CT
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-5100
Practice Address - Country:US
Practice Address - Phone:812-463-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174H00000XOther Service ProvidersHealth Educator