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NPI Code Detail

MEDICARE: STACEY L ADAMS

MEDICARE: STACEY L ADAMS
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1760039085
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY L ADAMS
Provider Business Mailing Address
First Line : 2435 20TH ST
Second Line :
City : RACINE
State : WI
Zip : 53403-2420
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4810 NORTHWESTERN AVE
Second Line :
City : MOUNT PLEASANT
State : WI
Zip : 53406-1504
Country : US
Telephone Number : 262-583-2714
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2019
Last Update Date : 08/21/2019

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Directions to “ STACEY L ADAMS ” Practice Location

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