Provider Demographics
NPI:1952577629
Name:RASZKIEWICZ, STEPHANIE R (PHD, CSAC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:R
Last Name:RASZKIEWICZ
Suffix:
Gender:F
Credentials:PHD, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1943
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53141-1943
Mailing Address - Country:US
Mailing Address - Phone:262-308-8085
Mailing Address - Fax:262-364-3679
Practice Address - Street 1:316 5TH ST STE 2
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-4606
Practice Address - Country:US
Practice Address - Phone:262-308-8085
Practice Address - Fax:262-364-3679
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15310-132101YA0400X
WI3002-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40968000Medicaid