Provider Demographics
NPI:1184479669
Name:STEFANCZYK, BRADY
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:STEFANCZYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5329 LACY RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5313
Mailing Address - Country:US
Mailing Address - Phone:920-207-8664
Mailing Address - Fax:
Practice Address - Street 1:11 13TH AVE
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-8919
Practice Address - Country:US
Practice Address - Phone:844-580-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician