DR. KIRK J. STUCKY (NPI# 1922153980) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1922153980 |
Entity Type | Individual |
Full Name | DR. KIRK J. STUCKY |
Credential | PSY.D. |
Practice Address |
2700 Robert T Longway Blvd Suite 1 Flint MI 48503-2190 |
Mailing Address |
1085 S Linden Rd Suite 150 Flint MI 48532-3421 |
Practice Telephone | 8102391975 |
Practice Fax Number | 8102391281 |
Mailing Telephone | 8107323240 |
Mailing Fax Number | 8102300280 |
Enumeration Date | 2007-01-23 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
X | 103G00000X | Clinical Neuropsychologist | 6301009785 | MI | Behavioral Health & Social Service Providers |
X | 103T00000X | Psychologist | 6301009785 | MI | Behavioral Health & Social Service Providers |
X | 103TR0400X |
Psychologist Specialization: Rehabilitation |
6301009785 | MI | Behavioral Health & Social Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MI | BCBS GROUP (ROBERT T) | OB54550 | 01 |
MI | BCBSM GROUP - HMC | OB51092 | 01 |
Street Address |
2700 ROBERT T LONGWAY BLVD SUITE 1 |
City | FLINT |
State | MI |
Zip Code | 48503-2190 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619965175 | Khalid Mohammed Ahmed | Internal Medicine | 2700 Robert T Longway Blvd, Suite B, Flint, MI 48503-2190 | 2005-10-10 |
1871060129 | Trisha Louise Krul | Assistant Behavior Analyst | 2700 Robert T Longway Blvd, Flint, MI 48503-2190 | 2018-10-25 |
1447726450 | Sheeba Mathews | Nurse Practitioner | 2700 Robert T Longway Blvd, Flint, MI 48503-2190 | 2018-10-17 |
1700388089 | Nichole Lynn Thornton | Behavior Technician | 2700 Robert T Longway Blvd, Flint, MI 48503 | 2018-03-02 |
1013429430 | Broc Stephen Wilkison | Assistant Behavior Analyst | 2700 Robert T Longway Blvd, Flint, MI 48503-2190 | 2017-10-25 |
1053839910 | Rebekah Plantz | Technician/Technologist | 2700 Robert T Longway Blvd, Flint, MI 48503-2190 | 2017-08-31 |
1457881369 | Robert Joseph Moore | Behavior Technician | 2700 Robert T Longway Blvd, Flint, MI 48503-2190 | 2017-06-13 |
1982131819 | Samantha Jo Wolf | Behavior Technician | 2700 Robert T Longway Blvd, Flint, MI 48503-2190 | 2017-05-23 |
1952834921 | Monica Leverette | Nurse Practitioner | 2700 Robert T Longway Blvd, Suite B, Flint, MI 48503-2190 | 2017-04-06 |
1356893366 | Shauna Franice Cooks | Nurse Practitioner | 2700 Robert T Longway Blvd, Suite B, Flint, MI 48503-2190 | 2016-10-26 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457971640 | Flint Odyssey House Inc. | Community/Behavioral Health | 1219 Martin Luther King Avenue, Flint, MI 48503 | 2020-04-17 |
1891265476 | Mary Margaret Woodruff | Health Educator | 411 E. Third St Suite 2, Flint, MI 48503 | 2018-11-27 |
1669942223 | Donna Jean Phelps | Behavior Technician | 2284 S Ballenger Highway, Flint, MI 48503 | 2018-11-27 |
1588150601 | Dayonna Scott | Social Worker | Hope Network, 2830 Corunna Rd, Flint, MI 48503 | 2018-07-02 |
1801388020 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 2284 S Ballenger Hwy Ste F, Flint, MI 48503 | 2018-06-04 |
1134610504 | Swathi Gorle | Student in an Organized Health Care Education/Training Program | Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503 | 2018-05-22 |
1881128049 | Kara Garr | Registered Nurse | 805 Tuuri Pl, Flint, MI 48503 | 2017-04-14 |
1518405638 | Thomasinia Terrell | Peer Specialist | 422 W Fourth Ave, Flint, MI 48503 | 2017-02-09 |
1790231041 | Roslyn Boyce | Technician, Other | 2213 E. Court Street, Flint, MI 48503 | 2016-08-28 |
1689120818 | Yasmine Elhefnawy | Student in an Organized Health Care Education/Training Program | One Hurley Plaza 3d West, Flint, MI 48503 | 2016-08-28 |
Find all providers in zip 48503 |
Taxonomy Code | 103G00000X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Clinical Neuropsychologist |
An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992237176 | Lauren Marie Golla | Clinical Neuropsychologist | 111 E Court St Ste 1b, Flint, MI 48502-1649 | 2017-03-28 |
1922556406 | Kenya Hameed | Clinical Neuropsychologist | 111 East Court St, Suite 1b-1, Flint, MI 48502 | 2016-09-14 |
1861682577 | Sharon Ruth Nassau | Clinical Neuropsychologist | 1290 S Graham Rd, Flint, MI 48532-3535 | 2007-07-29 |
1588728208 | Elizabeth R. Outman | Clinical Neuropsychologist | 1 Hurley Plz, Flint, MI 48503-5902 | 2006-12-20 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265046098 | Axon Psychology Group, PC | Clinical Neuropsychologist | 1377 Stonecreek Ct, Saint Joseph, MI 49085-9795 | 2020-08-31 |
1548814965 | Emily Nicole Robinett-ferrara | Clinical Neuropsychologist | 14050 Kingston St, Oak Park, MI 48237-1140 | 2019-07-25 |
1649782244 | Matthew Kadrich | Clinical Neuropsychologist | 3334 Rochester Rd # 205, Troy, MI 48083-5426 | 2017-11-04 |
1750839783 | Ace Psychological Consultants LLC | Clinical Neuropsychologist | 1920 Livernois Rd Ste D, Troy, MI 48083-1770 | 2016-09-20 |
1841609369 | Crystal Young | Clinical Neuropsychologist | 1550 E Beltline Ave Se, Suite 340, Grand Rapids, MI 49506-4301 | 2014-08-08 |
1497165146 | Woojin Song | Clinical Neuropsychologist | 2101 Commonwealth Blvd Ste C, Ann Arbor, MI 48105-2969 | 2014-05-03 |
1831516152 | Ira Lourie, Psy.d., Pllc | Clinical Neuropsychologist | 30051 High Valley Rd, Farmington Hills, MI 48331-2144 | 2014-03-25 |
1306272042 | Erin Mark | Clinical Neuropsychologist | 2010 Hogback Rd Ste 6g, Ann Arbor, MI 48105-8800 | 2013-09-25 |
1326388554 | Timothy Grayson Royer | Clinical Neuropsychologist | 3790 30th St Sw, Grandville, MI 49418-1602 | 2013-02-25 |
1801164496 | Veronica Ichikawa Dillon | Clinical Neuropsychologist | 5600 Meadow Dr, Ann Arbor, MI 48105-9368 | 2011-12-09 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.