Individual
REBECCA STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
1810 APPLETON RD, MENASHA, WI 54952
(920) 739-4226
(920) 432-5966
Mailing address
PO BOX 22308, GREEN BAY, WI 54305-2308
(920) 436-6800
(920) 432-5966
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6946-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912422155
—
WI
01
—
6946-125
STATE OF WISCONSIN
WI
Enumeration date
08/09/2017
Last updated
06/24/2022
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