Provider Demographics
NPI:1598560419
Name:STANISLAWSKI, TRACEY LEE (EDD, MSW, APSW)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:LEE
Last Name:STANISLAWSKI
Suffix:
Gender:F
Credentials:EDD, MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 S 157TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5104
Mailing Address - Country:US
Mailing Address - Phone:414-916-3759
Mailing Address - Fax:
Practice Address - Street 1:1300 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2602
Practice Address - Country:US
Practice Address - Phone:414-916-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135342121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty