Provider Demographics
NPI:1528877529
Name:MULHEIM, STACY MARIE (HIS)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:MULHEIM
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2820
Mailing Address - Country:US
Mailing Address - Phone:330-491-9810
Mailing Address - Fax:330-491-9815
Practice Address - Street 1:4156 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2820
Practice Address - Country:US
Practice Address - Phone:330-491-9810
Practice Address - Fax:330-491-9815
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.03319237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist