Provider Demographics
NPI:1649666926
Name:LUTHER, STACY MARIE STEFANIAK (PSYD)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE STEFANIAK
Last Name:LUTHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3930
Mailing Address - Country:US
Mailing Address - Phone:715-842-9500
Mailing Address - Fax:715-848-0425
Practice Address - Street 1:630 S 36TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3930
Practice Address - Country:US
Practice Address - Phone:715-842-9500
Practice Address - Fax:715-848-0425
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2499 - 226101YP2500X
WI4116-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional