Provider Demographics
NPI:1326123175
Name:STEPHEN, WILLIAM (MS, CADC III)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:STEPHEN
Suffix:
Gender:M
Credentials:MS, CADC III
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16535 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5936
Mailing Address - Country:US
Mailing Address - Phone:262-789-1191
Mailing Address - Fax:262-821-6180
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:414-817-9331
Practice Address - Fax:414-817-0442
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI397-857-00Medicaid