Active NPI
Tina Staszak, LPC-IT
- Professional Counselor
- Glendale, WI
National Provider Identifier
1962946095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 7063-125
- Practice address
- 5235 N Ironwood Rd
Glendale, WI 53217-4906 - Phone
- (414) 902-1519
- NPI assigned
- Dec 8, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 7063-125 | WI | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 17478-130 | WI |
Addresses
Primary practice location
5235 N Ironwood Rd
Glendale, WI 53217-4906
Mailing address
5235 N Ironwood Rd
Glendale, WI 53217-4906
Phone (414) 902-1519
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17478-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 7063-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777334400000",
"number": "1962946095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5235 N IRONWOOD RD",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532174906",
"telephone_number": "414-902-1519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5235 N IRONWOOD RD",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532174906",
"telephone_number": "414-902-1519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STASZAK",
"first_name": "TINA",
"credential": "LPC-IT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-08",
"last_updated": "2026-04-28",
"certification_date": "2026-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "7063-125",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "17478-130",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.