Healthcare Provider Details

I. General information

NPI: 1104473651
Provider Name (Legal Business Name): STEPHANIE A. ZETTEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WISCONSIN AVE STE 1500
MILWAUKEE WI
53202-4808
US

IV. Provider business mailing address

111 E WISCONSIN AVE STE 1500
MILWAUKEE WI
53202-4808
US

V. Phone/Fax

Practice location:
  • Phone: 414-239-9731
  • Fax: 414-677-7198
Mailing address:
  • Phone: 414-239-9731
  • Fax: 414-677-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19659-130
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8562
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8562-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: