Provider Demographics
NPI:1972049740
Name:STOLP, MARTHA (LPC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:STOLP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1125
Mailing Address - Country:US
Mailing Address - Phone:715-497-4408
Mailing Address - Fax:
Practice Address - Street 1:2004 HIGHLAND AVE
Practice Address - Street 2:SUITE 2N
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4400
Practice Address - Country:US
Practice Address - Phone:715-835-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3400-226101YP2500X
WI7225-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional