Moore, Stacey L
Moore, Stacey L is an individual health care provider with primary practice located at 1220 Dewey Ave , Wauwatosa WI 53213-2504. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Moore, Stacey L can be contacted via phone (414) 454-6600.Contact Information
Primary practice address
1220 Dewey Ave
Wauwatosa WI 53213-2504
Phone: (414) 454-6600
Fax: (414) 454-6450
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 3571 | Wisconsin |
Profile Details
| NPI number | 1225210206 |
|---|---|
| LBN Legal business name | Moore, Stacey L |
| Credentials | Licensed Professional Counselor (LPC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 30th, 2007 |
| Last updated | Nov 30th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225210206 | NPPES |
| Wisconsin | MEDICAID | 40995500 |
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