Provider Demographics
NPI:1720443377
Name:RICHARD-BAAL, STACEY (MSW, LCSW, LISW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:RICHARD-BAAL
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 INDIANA CT
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-5482
Mailing Address - Country:US
Mailing Address - Phone:563-581-2064
Mailing Address - Fax:
Practice Address - Street 1:6058 S CHESTNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-8947
Practice Address - Country:US
Practice Address - Phone:608-342-4853
Practice Address - Fax:608-348-3072
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074703104100000X
WI130055-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker