Provider Demographics
NPI:1346056389
Name:VENDITTO, STACY LEE (PHD)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LEE
Last Name:VENDITTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 INDIAN BEND RD
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-6521
Mailing Address - Country:US
Mailing Address - Phone:928-498-7372
Mailing Address - Fax:928-498-7372
Practice Address - Street 1:4085 INDIAN BEND RD
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-6521
Practice Address - Country:US
Practice Address - Phone:928-498-7372
Practice Address - Fax:928-498-7372
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral