Ibarra Stafford, Marie D.

Ibarra Stafford, Marie D. is an individual health care provider with primary practice located at 3860 Monroe Rd , De Pere WI 54115-8399. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Ibarra Stafford, Marie D. can be contacted via phone (920) 496-4700.

Contact Information

Primary practice address
3860 Monroe Rd De Pere WI 54115-8399
Phone: (920) 496-4700
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 6156-125 Wisconsin
Behavioral Health & Social Service Providers / Professional 101YP2500X 6156-125 Wisconsin

Profile Details

NPI number 1043763956
LBN Legal business name Ibarra Stafford, Marie D.
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2016
Last updated Mar 14th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043763956 NPPES
Wisconsin MEDICAID 100058688

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