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NPI Code Detail

MEDICARE: TINA STASZAK LPC-IT

MEDICARE: TINA STASZAK LPC-IT
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
1101YM0800XMental Health Counselor3348-226WI
2101YA0400XAddiction (Substance Use Disorder) Counselor17478-130WI

General Provider Information

NPI Number : 1962946095
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA STASZAK LPC-IT
Provider Business Mailing Address
First Line : 5235 N IRONWOOD RD
Second Line :
City : GLENDALE
State : WI
Zip : 53217-4906
Country : US
Telephone Number : 414-902-1519
Fax Number :
Provider Business Practice Location Address
First Line : 5235 N IRONWOOD RD
Second Line :
City : GLENDALE
State : WI
Zip : 53217-4906
Country : US
Telephone Number : 414-902-1519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2016
Last Update Date : 12/08/2016

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Directions to “ TINA STASZAK LPC-IT” Practice Location

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