Provider Demographics
NPI:1750830865
Name:STAGE, TODD ARTHUR (LCSW)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ARTHUR
Last Name:STAGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 JONQUIL LN
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7534
Mailing Address - Country:US
Mailing Address - Phone:616-337-3838
Mailing Address - Fax:
Practice Address - Street 1:1702 JONQUIL LN
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7534
Practice Address - Country:US
Practice Address - Phone:616-337-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8170-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical