Individual
STEPHANIE ROSS POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
700 N WESTHAVEN DR, OSHKOSH, WI 54904-6947
(920) 456-2030
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
071.010747
IL
103G00000X
Clinical Neuropsychologist
2018013237
MO
103G00000X
Clinical Neuropsychologist
Primary
5131
WI
103T00000X
Psychologist
071.010747
IL
103T00000X
Psychologist
2018013237
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100266414
—
WI
Enumeration date
07/18/2019
Last updated
09/10/2024
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