Provider Demographics
NPI:1144528175
Name:SALYERS, STACEY L (LCSW)
Entity type:Individual
Prefix:MR
First Name:STACEY
Middle Name:L
Last Name:SALYERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:MS 958
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-6238
Practice Address - Street 1:1466 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2919
Practice Address - Country:US
Practice Address - Phone:715-341-6672
Practice Address - Fax:715-341-8004
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI8279-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144528715Medicaid