Provider Demographics
NPI:1326113275
Name:STOUFFER, WARREN D (CADC II)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:D
Last Name:STOUFFER
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871
Mailing Address - Country:US
Mailing Address - Phone:715-468-7957
Mailing Address - Fax:
Practice Address - Street 1:24670 STATE RD 35 70
Practice Address - Street 2:SUITE 1200 AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872
Practice Address - Country:US
Practice Address - Phone:715-349-7233
Practice Address - Fax:715-349-7205
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12425101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39398600Medicaid