Provider Demographics
NPI:1346866910
Name:STOLER, MADISEN JESSICA (LPC)
Entity Type:Individual
Prefix:
First Name:MADISEN
Middle Name:JESSICA
Last Name:STOLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 W VIGO TER
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3649
Mailing Address - Country:US
Mailing Address - Phone:402-415-8585
Mailing Address - Fax:
Practice Address - Street 1:2524 E WEBSTER PL STE 203
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4257
Practice Address - Country:US
Practice Address - Phone:414-376-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8527-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional