Provider Demographics
NPI:1922109461
Name:HUESEMAN, STEPHANIE L (MS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:HUESEMAN
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Gender:F
Credentials:MS, LCSW
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Mailing Address - Street 1:602 WALDOCH DR
Mailing Address - Street 2:SUITE 100/NORTH PARK CLINICAL COUNSELING
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8445
Mailing Address - Country:US
Mailing Address - Phone:920-560-5531
Mailing Address - Fax:920-560-5533
Practice Address - Street 1:602 WALDOCH DR
Practice Address - Street 2:SUITE 100/NORTH PARK CLINICAL COUNSELING
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8445
Practice Address - Country:US
Practice Address - Phone:920-560-5531
Practice Address - Fax:920-560-5533
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-10-27
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3745-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41001500Medicaid