Provider Demographics
NPI:1912422155
Name:STEVENS, REBECCA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22308
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2308
Mailing Address - Country:US
Mailing Address - Phone:920-436-6800
Mailing Address - Fax:920-432-5966
Practice Address - Street 1:1810 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952
Practice Address - Country:US
Practice Address - Phone:920-739-4226
Practice Address - Fax:920-432-5966
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6946-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1912422155Medicaid
WI6946-125OtherSTATE OF WISCONSIN