Provider Demographics
NPI:1699267245
Name:GILBERT, STEPHENIE M (BS)
Entity type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:M
Last Name:GILBERT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:STEPHENIE
Other - Middle Name:M
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5263 BISHOPS BAY PKWY UNIT 110
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53597-8805
Mailing Address - Country:US
Mailing Address - Phone:941-448-0093
Mailing Address - Fax:
Practice Address - Street 1:1955 W BROADWAY STE 105
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-3700
Practice Address - Country:US
Practice Address - Phone:608-514-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)