Provider Demographics
NPI:1659595759
Name:WILSON, STEPHANIE A (MS,CSW, LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS,CSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454B 180TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-7530
Mailing Address - Country:US
Mailing Address - Phone:715-557-1744
Mailing Address - Fax:
Practice Address - Street 1:520 S WASHINGTON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-3500
Practice Address - Country:US
Practice Address - Phone:715-246-4840
Practice Address - Fax:715-246-4108
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5848-125101YP2500X
WI7308 120171M00000X
WI2057-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator