Provider Information for 1972176931
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Mrs. STACEY POLSON MS, LPC, NBCC
Sex: Female
NPI: 1972176931
Last Updated: 2021-07-19
Certification Date: 2021-07-19
Certification Date: 2021-07-19
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1972176931 | ||||||||
| Enumeration Date | 2021-07-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2754 SINKS CANYON RD LANDER, WY 82520-9714 United States Phone: 307-349-6012 | Fax: | ||||||||
| Primary Practice Address | 2754 SINKS CANYON RD LANDER, WY 82520-9714 United States Phone: 307-349-6012 | Fax: | ||||||||
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