Provider Demographics
NPI:1013326651
Name:STELMACH, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:STELMACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21836 ONLY AVE
Mailing Address - Street 2:
Mailing Address - City:ALTURA
Mailing Address - State:MN
Mailing Address - Zip Code:55910-4107
Mailing Address - Country:US
Mailing Address - Phone:608-519-5906
Mailing Address - Fax:608-519-5908
Practice Address - Street 1:444 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4099
Practice Address - Country:US
Practice Address - Phone:608-519-5906
Practice Address - Fax:608-519-5908
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16375-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI260000192Medicare PIN