Provider Demographics
NPI:1528387560
Name:STORKSON, STEPHANI JANE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANI
Middle Name:JANE
Last Name:STORKSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MISS
Other - First Name:STEPHANI
Other - Middle Name:JANE
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:629 RIVER ST STE C
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9189
Mailing Address - Country:US
Mailing Address - Phone:608-424-9100
Mailing Address - Fax:608-424-9099
Practice Address - Street 1:629 RIVER ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9189
Practice Address - Country:US
Practice Address - Phone:608-424-9100
Practice Address - Fax:608-424-9099
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI905-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist