Provider Demographics
NPI:1891404463
Name:STEDWELL, CASSIDY (LPC-IT)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:STEDWELL
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 COUNTY ROAD K STE 3
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-9251
Mailing Address - Country:US
Mailing Address - Phone:608-776-4800
Mailing Address - Fax:
Practice Address - Street 1:15701 COUNTY ROAD K STE 3
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-9251
Practice Address - Country:US
Practice Address - Phone:608-776-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7063-226101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor