Individual
STACEY JO ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC-IT
Contact information
Practice address
2314 N GRANDVIEW BLVD STE 207, WAUKESHA, WI 53188-1675
(262) 251-1112
Mailing address
2314 N GRANDVIEW BLVD STE 207, WAUKESHA, WI 53188-1675
(262) 251-1112
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7516-226
WI
Other
Enumeration date
09/04/2024
Last updated
09/04/2024
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