Doctor Name: | STACEY R GEDEON |
NPI Number: | 1336172485 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | 6301010429 |
Business Practice Address: | 9249 W Lake City Rd Houghton Lake, MI - 486299602 |
Business Phone Number: | 9894225122 |
Business Fax Number: | 9894224378 |
Mailing Address: | 9249 W Lake City Rd, HOUGHTON LAKE |
State: | MI |
Postal Code: | 486299602 |
Phone Number: | 9894225122 |
Fax Number: | 9894224378 |
NPI Enumeration Date: | 07/09/2006 |
NPI Last Update Date: | 09/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 6301010429 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |