Provider Demographics
NPI:1942934153
Name:SIMKINS, STACIE MARIE
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:MARIE
Last Name:SIMKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:STACIE
Other - Middle Name:MARIE
Other - Last Name:BEAUCHAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 KABEL AVE
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3918
Mailing Address - Country:US
Mailing Address - Phone:715-361-2805
Mailing Address - Fax:
Practice Address - Street 1:1020 KABEL AVE
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3918
Practice Address - Country:US
Practice Address - Phone:715-361-2805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7041-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7041-226Medicaid