Michelle Lois Stackhouse, PEER SUPPORT

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

00030 Issued in OH

Practice address

5736 East Blvd NW
Canton, OH 44718-1655

Phone

(330) 806-1953

NPI assigned

Sep 19, 2018

Last updated

Sep 19, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Michelle Lois Beyer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1396229027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5736 EAST BLVD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447181655",
            "telephone_number": "330-806-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5736 EAST BLVD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447181655",
            "telephone_number": "330-806-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "MICHELLE",
        "middle_name": "LOIS",
        "name_prefix": "Mrs.",
        "credential": "PEER SUPPORT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "00030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICAN, INC.",
            "identifier": "34-1575839",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "BEYER",
            "middle_name": "LOIS",
            "prefix": "MRS.",
            "credential": "PEER SUPPORT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cornelius Ssekitto
• Cassandra St. Clair
• Stacey Young OD Inc (Eyecare Specialties)
• David Craig Stachel, MD
• Madison Stackhouse
• Shelly Renee Stafford, STNA
• Samantha Ray Stage
• Danijela M Stahr, LPCC-S
• Jenna Staikoff, AA
• Leberliza Stalcup, RN

• Peer Specialist in Canton, OH
• Providers in Canton, OH by specialty
• Peer Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.