Most Relevant Information
Provider Data
| NPI Number: | 1003442542 |
| Provider Name: | STACEY GROCKE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/17/2020 |
| Last Updated: | 03/17/2020 |
Provider Practice Location
10014 N DALE MABRY HWY
TAMPA
FL
336184426
Practice Location Phone/Fax
| Phone: | 8003564049 |
| Fax: |
Provider Mailing Location
10014 N DALE MABRY HWY
TAMPA
FL
336184426
Provider Mailing Phone/Fax
| Phone: | 8003564049 |
| Fax: |