1306085089 NPI number — MRS. SENA C YERGES LPC, NCC

Table of content: MRS. SENA C YERGES LPC, NCC (NPI 1306085089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306085089 NPI number — MRS. SENA C YERGES LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YERGES
Provider First Name:
SENA
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306085089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 245039
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-368-6070
Provider Business Mailing Address Fax Number:
414-368-6073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
757 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
FOND DU LAC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-731-9798
Provider Business Practice Location Address Fax Number:
920-731-0197
Provider Enumeration Date:
02/19/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  97-226 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 4336-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)