Individual
STACY M. CONDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
903 MINERAL POINT AVE, JANESVILLE, WI 53548-2970
(608) 756-5555
(608) 756-0174
Mailing address
903 MINERAL POINT AVE, JANESVILLE, WI 53548-2970
(608) 756-5555
(608) 756-0174
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
130509-121
WI
1041C0700X
Clinical Social Worker
Primary
9109-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639617855
—
WI
01
—
K400361223-000084908
WI MEDICARE
WI
Enumeration date
02/08/2017
Last updated
03/27/2019
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