Provider Demographics
NPI:1609956242
Name:STANIK, PATRICIA CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:CAROL
Last Name:STANIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 S 102ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2466
Mailing Address - Country:US
Mailing Address - Phone:414-800-7645
Mailing Address - Fax:414-800-7647
Practice Address - Street 1:2448 S 102ND ST
Practice Address - Street 2:SUITE 270
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2466
Practice Address - Country:US
Practice Address - Phone:414-800-7645
Practice Address - Fax:414-800-7647
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1998103G00000X, 103TR0400X, 103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1998OtherSTATE LICENSE
WI000244505Medicare ID - Type Unspecified