Provider Demographics
NPI:1316393960
Name:STELLMACHER, REBECCA (LPC-IT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STELLMACHER
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 KENWOOD DR
Mailing Address - Street 2:STE. 1
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1161
Mailing Address - Country:US
Mailing Address - Phone:920-886-9319
Mailing Address - Fax:920-886-9357
Practice Address - Street 1:1478 KENWOOD DR
Practice Address - Street 2:STE. 1
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1161
Practice Address - Country:US
Practice Address - Phone:920-886-9319
Practice Address - Fax:920-886-9357
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2988-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional