Provider Demographics
NPI:1992576342
Name:HUTCHINSON, STACY M
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20286 EMERY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RANDALL
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4123
Mailing Address - Country:US
Mailing Address - Phone:216-347-6175
Mailing Address - Fax:
Practice Address - Street 1:20286 EMERY RD
Practice Address - Street 2:
Practice Address - City:NORTH RANDALL
Practice Address - State:OH
Practice Address - Zip Code:44128-4123
Practice Address - Country:US
Practice Address - Phone:216-347-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X
OHRF681168172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No385H00000XRespite Care FacilityRespite Care