Provider Demographics
NPI:1174615561
Name:HSHIEH, STELLA Y (EDD)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:Y
Last Name:HSHIEH
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-0369
Mailing Address - Country:US
Mailing Address - Phone:330-854-5503
Mailing Address - Fax:330-854-5603
Practice Address - Street 1:1724 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9313
Practice Address - Country:US
Practice Address - Phone:330-854-5503
Practice Address - Fax:330-854-5603
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5163103TA0700X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2028255Medicaid
OHCP19223Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST
OHS29157Medicare UPIN