Facts
- Status
- A
- Credential
- MA, LPC
- Type
- Individual
- Enumeration date
- 2013-05-05
- Last updated
- 2023-04-11
Specialties
Licenses
- License WI
- Number not in the file
Location
- Practice location
- 3704 WESTON AVE
- City
- WESTON WI
- Postal code
- 544765242
- Phone
- 715-298-6364
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.