Provider Demographics
NPI:1093165573
Name:STAGER, WHITNEY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:
Last Name:STAGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E WAYFARER LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-6357
Mailing Address - Country:US
Mailing Address - Phone:920-851-8266
Mailing Address - Fax:
Practice Address - Street 1:120 W 8TH ST
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2312
Practice Address - Country:US
Practice Address - Phone:920-851-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI802-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist