Provider Demographics
NPI:1164583068
Name:STOCKER, VIRGINIA D (VIRGINIA STOCKER)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:D
Last Name:STOCKER
Suffix:
Gender:F
Credentials:VIRGINIA STOCKER
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:D
Other - Last Name:LUECKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:845 E GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5217
Mailing Address - Country:US
Mailing Address - Phone:414-962-1947
Mailing Address - Fax:
Practice Address - Street 1:3970 N OAKLAND AVE
Practice Address - Street 2:#502
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-332-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI338-1281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical