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NPI Code Detail

MEDICARE: STEPHANIE GUDMUNSEN LCSW

MEDICARE: STEPHANIE GUDMUNSEN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker7293-123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407941446
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE GUDMUNSEN LCSW
Provider Business Mailing Address
First Line : 111 W JACKSON ST
Second Line :
City : WISCONSIN RAPIDS
State : WI
Zip : 54495-2702
Country : US
Telephone Number : 715-421-8845
Fax Number : 715-421-2266
Provider Business Practice Location Address
First Line : 111 W JACKSON ST
Second Line :
City : WISCONSIN RAPIDS
State : WI
Zip : 54495-2702
Country : US
Telephone Number : 715-421-8845
Fax Number : 715-421-2266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 10/10/2025

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