Doctor Name: | TRACIE JENNIFER STEWART |
NPI Number: | 1194150037 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC |
License Number: | 5793-125 |
Business Practice Address: | 3900 W Brown Deer Rd Suite A, Pmb 117 Brown Deer, WI - 532091220 |
Business Phone Number: | 4144658101 |
Business Fax Number: | |
Mailing Address: | 3900 W Brown Deer Rd, Suite A, Pmb 117 BROWN DEER |
State: | WI |
Postal Code: | 532091220 |
Phone Number: | 4144658101 |
Fax Number: | |
NPI Enumeration Date: | 09/11/2013 |
NPI Last Update Date: | 09/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5793-125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |