MEDICARE: MADISEN JESSICA STOLER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8527-125	WI

General Provider Information

NPI Number	:	1346866910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISEN JESSICA STOLER LPC

Provider Business Mailing Address
First Line	:	9820 W VIGO TER
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-3649
Country	:	US
Telephone Number	:	402-415-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2524 E WEBSTER PL STE 203
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4257
Country	:	US
Telephone Number	:	414-376-3733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	11/27/2023

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