Individual
STEPHANIE RAE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLC
Contact information
Practice address
5126 MARTHA DR, WEST BEND, WI 53095-8794
(262) 501-1359
Mailing address
5126 MARTHA DR, WEST BEND, WI 53095-8794
(262) 501-1359
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
ALPP-42079
WI
Other
Enumeration date
12/22/2017
Last updated
06/11/2019
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