MEDICARE: MS. STEPHANIE L HUESEMAN M.S., 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
1	1041C0700X	Clinical Social Worker	3745-123	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922109461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE L HUESEMAN M.S., LCSW

Provider Business Mailing Address
First Line	:	602 WALDOCH DR
Second Line	:	SUITE 100/NORTH PARK CLINICAL COUNSELING
City	:	APPLETON
State	:	WI
Zip	:	54913-8445
Country	:	US
Telephone Number	:	920-560-5531
Fax Number	:	920-560-5533

Provider Business Practice Location Address
First Line	:	602 WALDOCH DR
Second Line	:	SUITE 100/NORTH PARK CLINICAL COUNSELING
City	:	APPLETON
State	:	WI
Zip	:	54913-8445
Country	:	US
Telephone Number	:	920-560-5531
Fax Number	:	920-560-5533

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	10/27/2007

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