Provider Demographics
NPI:1659580462
Name:SMITH-WHYBARK, STEPHANIE LYNN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SMITH-WHYBARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4060 N MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3121
Mailing Address - Country:US
Mailing Address - Phone:262-635-0525
Mailing Address - Fax:262-639-0524
Practice Address - Street 1:4060 N MAIN ST
Practice Address - Street 2:SUITE106
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-3121
Practice Address - Country:US
Practice Address - Phone:262-635-0525
Practice Address - Fax:262-639-0524
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI448-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist