Basic Information
| Provider Information | |||||||||
| NPI: | 1043726649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIRDLER | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LISW-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4772 ECHOMOORE DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432315959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142860861 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4653 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432133298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143847798 | ||||||||
| FaxNumber: | 6143847703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2017 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S.1200259 | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | I.1801019 | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | I.1801019-SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.