Healthcare Provider Details

I. General information

NPI: 1720472574
Provider Name (Legal Business Name): STEPHANIE MARIE FERGUSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5583 W WATERFORD LN STE C
APPLETON WI
54913-8441
US

IV. Provider business mailing address

5583 W WATERFORD LN STE C
APPLETON WI
54913-8441
US

V. Phone/Fax

Practice location:
  • Phone: 920-215-8976
  • Fax:
Mailing address:
  • Phone: 920-215-8967
  • Fax: 920-215-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6458-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: