Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 1998 | WI |
N | 103TC0700X | Clinical Psychologist | 1998 | WI |
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 1998 | WI |
Y | 103TC0700X | Clinical Psychologist | 1998 | WI |
N | 103TR0400X | Rehabilitation Psychologist | 1998 | WI |
NPI | 1609956242 |
---|---|
Provider Name | Dr. Patricia Carol Stanik |
First Address | West Allis, WI 53227-2466 |
Second Address | West Allis, WI 53227-2466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 14/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1998 | STATE LICENSE (01) | WI |