Provider Demographics
NPI:1912778341
Name:JONES, STACEY L
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1112 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-1648
Mailing Address - Country:US
Mailing Address - Phone:513-375-8967
Mailing Address - Fax:
Practice Address - Street 1:1112 BEECH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-1648
Practice Address - Country:US
Practice Address - Phone:513-375-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child