Provider Demographics
NPI:1679506661
Name:HAMANN, STEPHANIE JO (MA, LPC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:JO
Last Name:HAMANN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
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Mailing Address - Street 1:9000 W WISCONSIN AVE # MS 958
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-6238
Practice Address - Street 1:705 S 24TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5242
Practice Address - Country:US
Practice Address - Phone:715-848-1457
Practice Address - Fax:715-848-2959
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3379-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679506661Medicaid
WI89589OtherSECURITY HEALTH PLAN
391640073002OtherTRICARE
332602OtherMANAGED HEALTH NETWORK