Stacy Marie Brewer

Key facts

NPI

1306595178

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Technician 106S00000X

Practice address

2521 N Elms Rd
Flushing, MI 48433-9423

Phone

(866) 498-3909

NPI assigned

Mar 21, 2022

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

Other names

• Miss Stacy Marie Podhorsky Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 21, 2022.

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1306595178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2521 N ELMS RD",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484339423",
            "telephone_number": "866-498-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2521 N ELMS RD",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484339423",
            "telephone_number": "866-498-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREWER",
        "first_name": "STACY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-21",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "PODHORSKY",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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