=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447948161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINA CAROLE STOFFEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2023
-----------------------------------------------------
Last Update Date | 05/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5555 ODANA RD STE 202
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53719-1280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-515-8787
-----------------------------------------------------
Fax | 608-284-7482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1118 DEBRA LN
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53704-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-570-0894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------