Provider Demographics
NPI:1215617444
Name:KLEIN, STACY (LLBSW, MCJ)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LLBSW, MCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2310
Mailing Address - Country:US
Mailing Address - Phone:989-249-0929
Mailing Address - Fax:
Practice Address - Street 1:3150 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2310
Practice Address - Country:US
Practice Address - Phone:989-249-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852091349251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management