Individual
JODI STACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT-IT
Contact information
Practice address
1268 W MAIN ST, SUN PRAIRIE, WI 53590-1930
(608) 834-1122
Mailing address
1268 W MAIN ST, SUN PRAIRIE, WI 53590-1930
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1023-228
WI
Other
Enumeration date
05/24/2023
Last updated
05/24/2023
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