Provider Demographics
NPI:1306876909
Name:KENT, STACEY ANNE (LAC)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANNE
Last Name:KENT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANNE
Other - Last Name:IGANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1864
Mailing Address - Country:US
Mailing Address - Phone:614-595-6412
Mailing Address - Fax:
Practice Address - Street 1:1900 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1864
Practice Address - Country:US
Practice Address - Phone:614-595-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000022171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist