Provider Demographics
NPI:1396457495
Name:RADEMACHER VANCE, STACY K (PHD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:K
Last Name:RADEMACHER VANCE
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 1:6764 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-1126
Mailing Address - Country:US
Mailing Address - Phone:904-556-4639
Mailing Address - Fax:
Practice Address - Street 1:6764 WALNUT LN
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-1126
Practice Address - Country:US
Practice Address - Phone:904-556-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019235103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist