Provider Demographics
NPI:1639465933
Name:ZINUTICZ, STACY E (MS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:E
Last Name:ZINUTICZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:E
Other - Last Name:HOAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W156N8327 PILGRIM RD STE 402
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3776
Mailing Address - Country:US
Mailing Address - Phone:262-251-1112
Mailing Address - Fax:
Practice Address - Street 1:W156N8327 PILGRIM RD STE 402
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3776
Practice Address - Country:US
Practice Address - Phone:262-251-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5129-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5129-125OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES