Provider Demographics
NPI:1104255587
Name:REAUME, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:REAUME
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 1:1001 S RAISINVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9754
Mailing Address - Country:US
Mailing Address - Phone:734-243-7340
Mailing Address - Fax:
Practice Address - Street 1:17461 ALLEN RD
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1026
Practice Address - Country:US
Practice Address - Phone:313-920-8771
Practice Address - Fax:949-561-4887
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090988104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker