Provider Demographics
NPI:1316595614
Name:RISCHETTE, STACY (LAC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:RISCHETTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:RISCHETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54829-0362
Mailing Address - Country:US
Mailing Address - Phone:715-822-4418
Mailing Address - Fax:
Practice Address - Street 1:1268 2ND AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:WI
Practice Address - Zip Code:54829-7210
Practice Address - Country:US
Practice Address - Phone:715-822-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10139-146225700000X
WI958-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI958-55OtherWI LICENSE NUMBER