Provider Demographics
NPI:1164105383
Name:NOLAN, STEPHANIE JO
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:NOLAN
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:W20410 STATE ROAD 121
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-9147
Mailing Address - Country:US
Mailing Address - Phone:715-538-4312
Mailing Address - Fax:
Practice Address - Street 1:W20410 STATE ROAD 121
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-9147
Practice Address - Country:US
Practice Address - Phone:715-538-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3902226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional