Individual
STACY MARIE CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CRC, LPC-IT
Contact information
Practice address
322 DEWITT ST, PORTAGE, WI 53901-2114
(608) 280-2700
Mailing address
25 KESSEL CT STE 105, MADISON, WI 53711-6227
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3232
WI
Other
Enumeration date
09/13/2017
Last updated
09/13/2017
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