Provider Demographics
NPI:1982945325
Name:KLUCK, STACY JANE (LAC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JANE
Last Name:KLUCK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 MEDICAL PKWY STE 231
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4014
Mailing Address - Country:US
Mailing Address - Phone:512-383-6359
Mailing Address - Fax:
Practice Address - Street 1:3810 MEDICAL PKWY STE 231
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4014
Practice Address - Country:US
Practice Address - Phone:512-383-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01641171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist