Provider Demographics
NPI:1912419995
Name:MCVAY, STACEY LYNN
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LYNN
Last Name:MCVAY
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 1:10520 4TH AVE W UNIT B
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7048
Mailing Address - Country:US
Mailing Address - Phone:425-238-9075
Mailing Address - Fax:425-349-6836
Practice Address - Street 1:3322 BROADWAY FL 1
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4425
Practice Address - Country:US
Practice Address - Phone:425-349-7224
Practice Address - Fax:425-349-6836
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist