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General NPI Number Information
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NPI Number | 1326436171
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Entity Type | Individual
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Provider Name | STACY BAMBERG LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 404 N MAIN ST STE 503
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City | OSHKOSH
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State | WI
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Zip | 54901-4952
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Country | US
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Telephone | 920-428-4298
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Fax |
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Provider Business Mailing Address
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Address Line | 1037 CARRIAGE LN
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City | FOND DU LAC
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State | WI
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Zip | 54935-6556
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Country | US
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Telephone | 920-428-4298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8792-123
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License Number State | WI
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