Individual
STACEY MAE KUBISIAK THOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC-IT
Contact information
Practice address
3930 8TH ST S STE 101, WISCONSIN RAPIDS, WI 54494-6511
(715) 423-2030
Mailing address
3930 8TH ST S STE 101, WISCONSIN RAPIDS, WI 54494-6511
(715) 423-2030
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3370-226
WI
Other
Enumeration date
05/10/2017
Last updated
05/10/2017
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