Provider Demographics
NPI:1053181404
Name:BLAIR, STACY L (MSW)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:L
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 FARMLAND DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-3356
Mailing Address - Country:US
Mailing Address - Phone:740-272-1259
Mailing Address - Fax:
Practice Address - Street 1:2089 FARMLAND DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-3356
Practice Address - Country:US
Practice Address - Phone:740-272-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant