Provider Demographics
NPI:1609692003
Name:DAHLKE, STACY (LPC-IT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:DAHLKE
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W10771 HOWARD DR W
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53933-9710
Mailing Address - Country:US
Mailing Address - Phone:920-382-1541
Mailing Address - Fax:
Practice Address - Street 1:150 MILLER ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-1320
Practice Address - Country:US
Practice Address - Phone:920-234-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7961226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional