1578617320 NPI number — WETZEL-RASMUSSEN COUNSELING SERVICES

Table of content: (NPI 1578617320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578617320 NPI number — WETZEL-RASMUSSEN COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WETZEL-RASMUSSEN COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1578617320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W10610 CLINIC STREET
Provider Second Line Business Mailing Address:
PO BOX 278
Provider Business Mailing Address City Name:
ELCHO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54428-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-275-3934
Provider Business Mailing Address Fax Number:
715-275-4510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W10610 CLINIC ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELCHO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54428-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-275-3934
Provider Business Practice Location Address Fax Number:
715-275-4533
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WETZEL RASMUSSEN
Authorized Official First Name:
NATALIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER LICENSED PROFESSIONAL COUNSEL
Authorized Official Telephone Number:
715-275-3934

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3361125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 35255020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 42237000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com