Most Relevant Information
Provider Data
| NPI Number: | 1003441379 |
| Provider Name: | STACEY JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 252Y00000X |
| Specialty: | Early Intervention Provider Agency |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/06/2020 |
| Last Updated: | 03/06/2020 |
Provider Practice Location
1002 S DILLARD ST STE 106
WINTER GARDEN
FL
347873991
Practice Location Phone/Fax
| Phone: | 4078770029 |
| Fax: | 4073585207 |
Provider Mailing Location
93 HILLSIDE DR
EUSTIS
FL
327267614
Provider Mailing Phone/Fax
| Phone: | 3526384583 |
| Fax: |