Healthcare Provider Details

I. General information

NPI: 1609700723
Provider Name (Legal Business Name): STEPHANIE KAEBISCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

N104W13840 DONGES BAY RD
GERMANTOWN WI
53022-4430
US

IV. Provider business mailing address

N162W21884 POPPY RD
JACKSON WI
53037-1219
US

V. Phone/Fax

Practice location:
  • Phone: 262-502-7121
  • Fax:
Mailing address:
  • Phone: 262-502-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: