Provider Demographics
NPI:1770843419
Name:KINNEY, STACIE LEE (SPECIAL ED TEACHER)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:LEE
Last Name:KINNEY
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 CR 6
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-5220
Mailing Address - Country:US
Mailing Address - Phone:315-393-4448
Mailing Address - Fax:
Practice Address - Street 1:5835 CR 6
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-5220
Practice Address - Country:US
Practice Address - Phone:315-393-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator