Active NPI
Stephanie Prevost, M.S.
- Professional Counselor
- De Pere, WI
National Provider Identifier
1053733162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2005-226
- Practice address
- 3860 Monroe Rd
De Pere, WI 54115-8399 - Phone
- (920) 496-4700
- NPI assigned
- Jan 8, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2005-226 | WI | Primary |
Addresses
Primary practice location
3860 Monroe Rd
De Pere, WI 54115-8399
Mailing address
3860 Monroe Rd
De Pere, WI 54115-8399
Phone (920) 496-4700
Other practice location 1
130 E Walnut St
Green Bay, WI 54301-4239
Phone (920) 437-8256
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005-226 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574812800000",
"number": "1053733162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3860 MONROE RD",
"city": "DE PERE",
"state": "WI",
"postal_code": "541158399",
"telephone_number": "920-496-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3860 MONROE RD",
"city": "DE PERE",
"state": "WI",
"postal_code": "541158399",
"telephone_number": "920-496-4700"
}
],
"practiceLocations": [
{
"address_1": "130 E Walnut St",
"address_purpose": "LOCATION",
"city": "Green Bay",
"state": "WI",
"postal_code": "543014239",
"country_code": "US",
"telephone_number": "920-437-8256",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PREVOST",
"first_name": "STEPHANIE",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-08",
"last_updated": "2019-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "2005-226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.