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NPI Code Detail

MEDICARE: STEPHANIE ISHAM

MEDICARE: STEPHANIE ISHAM
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
1101YA0400XAddiction (Substance Use Disorder) Counselor160217WI

General Provider Information

NPI Number : 1578912762
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE ISHAM
Provider Business Mailing Address
First Line : 3440 OAKWOOD HILLS PKWY
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3440 OAKWOOD HILLS PKWY
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701-7698
Country : US
Telephone Number : 800-380-8273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2016
Last Update Date : 06/08/2016

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