Individual
DR. STEPHANIE CAROL SMITH KELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
630 S 36TH AVE, WAUSAU, WI 54401-3930
(855) 607-8242
Mailing address
630 S 36TH AVE, WAUSAU, WI 54401-3930
(855) 607-8242
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
12262
NE
103K00000X
Behavior Analyst
RBT-18-65709
OK
103T00000X
Psychologist
Primary
4155-57
WI
103TS0200X
School Psychologist
—
—
Other
Enumeration date
11/30/2018
Last updated
10/13/2023
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