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NPI Code Detail

MEDICARE: GLENDA LYNN PROM-STANLICK LCSW

MEDICARE: GLENDA LYNN PROM-STANLICK LCSW
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
11041C0700XClinical Social Worker6775-123WI

General Provider Information

NPI Number : 1588516827
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENDA LYNN PROM-STANLICK LCSW
Provider Business Mailing Address
First Line : 383 WILLIAMSTOWNE STE 101
Second Line : SUITE 101
City : DELAFIELD
State : WI
Zip : 53018-2332
Country : US
Telephone Number : 262-337-9770
Fax Number : 262-337-9771
Provider Business Practice Location Address
First Line : 383 WILLIAMSTOWNE STE 101
Second Line : SUITE 101
City : DELAFIELD
State : WI
Zip : 53018-2332
Country : US
Telephone Number : 262-337-9770
Fax Number : 262-337-9771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2026
Last Update Date : 02/10/2026

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