Provider Demographics
NPI:1568796563
Name:NIELSEN, STANLEY KENNETH (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:KENNETH
Last Name:NIELSEN
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Gender:M
Credentials:MSW, LCSW
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Mailing Address - Street 1:5900 MONONA DRIVE, SUITE 100-SAMARITAN CONSELING CENTER
Mailing Address - Street 2:5900 MONONA DR., SUITE 100
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3556
Mailing Address - Country:US
Mailing Address - Phone:608-663-0763
Mailing Address - Fax:608-663-0765
Practice Address - Street 1:5900 MONONA DR STE 100
Practice Address - Street 2:5900 MONONA DR., SUITE 100
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3556
Practice Address - Country:US
Practice Address - Phone:608-663-0763
Practice Address - Fax:608-663-0765
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI150-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health