Active NPI
Stacey L Pendzich, LCSW
- Clinical Social Worker
- Green Bay, WI
National Provider Identifier
1811135205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7472-123
- Practice address
- 1967 Sylvan Dr
Green Bay, WI 54313-4824 - Phone
- (414) 708-1179
- NPI assigned
- Jan 23, 2009
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7472-123 | WI | Primary |
Addresses
Primary practice location
1967 Sylvan Dr
Green Bay, WI 54313-4824
Mailing address
1967 Sylvan Dr
Green Bay, WI 54313-4824
Phone (414) 708-1179
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7472-123 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin Community Mental Health Counseling Centers, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Mequon, WI
- NPI 1558440552
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773792000000",
"number": "1811135205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1967 SYLVAN DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543134824",
"telephone_number": "414-708-1179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1967 SYLVAN DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543134824",
"telephone_number": "414-708-1179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDZICH",
"first_name": "STACEY",
"middle_name": "L",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-23",
"last_updated": "2026-03-18",
"certification_date": "2026-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "7472-123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.