MEDICARE: HOLLY STONER LMFT

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	106H00000X	Marriage & Family Therapist	807-124	WI

General Provider Information

NPI Number	:	1467694240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY STONER LMFT

Provider Business Mailing Address
First Line	:	500 W SILVER SPRING DR
Second Line	:	SUITE K270
City	:	GLENDALE
State	:	WI
Zip	:	53217-5051
Country	:	US
Telephone Number	:	414-964-4357
Fax Number	:	414-964-4327

Provider Business Practice Location Address
First Line	:	500 W SILVER SPRING DR
Second Line	:	SUITE K270
City	:	GLENDALE
State	:	WI
Zip	:	53217-5051
Country	:	US
Telephone Number	:	414-964-4357
Fax Number	:	414-964-4327

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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Directions to “ HOLLY STONER LMFT” Practice Location

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