Provider Demographics
NPI:1750557559
Name:STONER, SCOTT (DMIN)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:STONER
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 N BAYSHORE DR
Mailing Address - Street 2:SUITE B204
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4540
Mailing Address - Country:US
Mailing Address - Phone:414-964-4357
Mailing Address - Fax:414-964-4327
Practice Address - Street 1:5800 N BAYSHORE DR
Practice Address - Street 2:SUITE B204
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4540
Practice Address - Country:US
Practice Address - Phone:414-964-4357
Practice Address - Fax:414-964-4327
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI783-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist