Individual
STACEY SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4864 N 21ST ST, MILWAUKEE, WI 53209-5748
(213) 800-6801
Mailing address
4864 N 21ST ST, MILWAUKEE, WI 53209-5748
(213) 800-6801
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
WI
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
WI
385H00000X
Respite Care
—
WI
Other
Enumeration date
05/12/2026
Last updated
05/12/2026
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