Provider Demographics
NPI:1265801641
Name:GLYNN, STACI M (LPC, SAC-IT)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:M
Last Name:GLYNN
Suffix:
Gender:F
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:M
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:JUNEAU COUNTY DEPT OF HUMAN SERVICES
Mailing Address - Street 2:200 HICKORY ST
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948
Mailing Address - Country:US
Mailing Address - Phone:608-847-2400
Mailing Address - Fax:608-847-9421
Practice Address - Street 1:JUNEAU COUNTY DEPT OF HUMAN SERVICES
Practice Address - Street 2:200 HICKORY ST
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948
Practice Address - Country:US
Practice Address - Phone:608-847-2400
Practice Address - Fax:608-847-9421
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5386101YP2500X
WI5386-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional