Individual
STACIE M KUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2842 S BUSINESS DR, SHEBOYGAN, WI 53081-6518
(920) 458-6527
(920) 458-6623
Mailing address
2422 N GRANDVIEW BLVD, WAUKESHA, WI 53188-6105
(262) 549-6600
(262) 549-6698
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15810-132
WI
101YM0800X
Mental Health Counselor
5761-125
WI
Other
Enumeration date
05/06/2010
Last updated
10/22/2015
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