Provider Demographics
NPI:1205204096
Name:KILLINGER, STACY L (PHD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:KILLINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 E WHISPERING PINES WAY
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-2266
Mailing Address - Country:US
Mailing Address - Phone:608-707-9444
Mailing Address - Fax:
Practice Address - Street 1:7617 MINERAL POINT RD STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1623
Practice Address - Country:US
Practice Address - Phone:608-833-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100048496Medicaid