Individual
COURTNEY STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
210 W CAPITOL DR, MILWAUKEE, WI 53212-1123
(414) 727-6320
Mailing address
1812 E HOWARD AVE, MILWAUKEE, WI 53207-4000
(708) 439-6893
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6859-125
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/07/2015
Last updated
10/20/2022
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