Provider Demographics
NPI:1871678581
Name:BRACKETT, STEPHANY RAU (CISW)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:RAU
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:CISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7946
Mailing Address - Country:US
Mailing Address - Phone:262-857-9697
Mailing Address - Fax:
Practice Address - Street 1:3734 7TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5525
Practice Address - Country:US
Practice Address - Phone:262-654-9370
Practice Address - Fax:262-654-9379
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI866-1221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical