Healthcare Provider Details

I. General information

NPI: 1942326053
Provider Name (Legal Business Name): STACEY ELIZABETH SOELDNER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E WALDO BLVD
MANITOWOC WI
54220-2905
US

IV. Provider business mailing address

21 E WALDO BLVD
MANITOWOC WI
54220-2905
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-3220
  • Fax:
Mailing address:
  • Phone: 920-683-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2510-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: