Staci M Glynn, LPC, SAC-IT
Individual provider Active NPI Professional Counselor · Mauston, WI
NPI 1265801641 · NPPES record last updated Sep 18, 2020
Key facts
- NPI
- 1265801641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 5386-125 (WI)
- Practice address
- Juneau County Dept of Human Services
200 Hickory St
Mauston, WI 53948 - Phone
- (608) 847-2400
- Fax
- (608) 847-9421
- NPI assigned
- Sep 16, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gundersen Clinic LTD
Practice addresses (Care Compare)
505 Gopher Dr
Tomah, WI 54660-4513
Phone (608) 372-4111
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240104001848 | WI | Practitioner - Mental Health Counselor | 4981055860 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5386-125 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gundersen Lutheran Medical Center Inc | Current |
Accepting new patients | |
| Gundersen Clinic, LTD. | Current |
Accepting new patients | |
| Gundersen Clinic LTD | Current | Accepting new patients | |
| Gundersen Lutheran Express Care, Inc | Current |
Accepting new patients | |
| Gundersen Lutheran Medical Center, Inc | Current |
Accepting new patients | |
| Gundersen Lutheran Medical Center Inc | Current | Accepting new patients |
Locations
402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331
1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102
1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287
505 Gopher Dr
Tomah, WI 54660
Phone (608) 372-2181
Interoperability endpoints
- sglynn496380@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5386 | WI | |
| Professional Counselor | 101YP2500X | 5386-125 | WI | Yes |
Addresses
Primary practice location
Juneau County Dept of Human Services
200 Hickory St
Mauston, WI 53948
Mailing address
Juneau County Dept of Human Services
200 Hickory St
Mauston, WI 53948
Phone (608) 847-2400
Other names
- Staci M Pierce
Other providers in Mauston, WI
- Jaycie Gee
- Cassidy Grace Geersen
- Genevieve Helen Geffert
- Joann Geiger
- Mary Ann Gerrard
- Shaylyn Goldbeck
- James Michael Grannell
- Tamara Green
- Lisa Ruth Gregar
- Craig William Griffis
All providers in Mauston, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.