Provider Demographics
NPI:1881452423
Name:WAKELEY, STACEY JANE (LMSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:JANE
Last Name:WAKELEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2782 S OTSEGO AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9404
Mailing Address - Country:US
Mailing Address - Phone:989-732-7525
Mailing Address - Fax:989-732-6577
Practice Address - Street 1:2782 S OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9404
Practice Address - Country:US
Practice Address - Phone:989-732-7525
Practice Address - Fax:989-732-6577
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010871451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical