Provider Demographics
NPI:1164382487
Name:BRUMAGE, STACEY PEARLENE
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:PEARLENE
Last Name:BRUMAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1340
Mailing Address - Country:US
Mailing Address - Phone:567-674-1214
Mailing Address - Fax:
Practice Address - Street 1:1385 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1340
Practice Address - Country:US
Practice Address - Phone:567-674-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator