Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6124 | WI |
NPI | 1003268277 |
---|---|
Provider Name | Stephanie Pattengale |
First Address | Waukesha, WI 53188-5071 |
Second Address | Waukesha, WI 53188-5071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2016 |
Last Update Date | 12/07/2016 |