| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1 Bank Ave, Kaukauna, Wisconsin |
| Authorized Official Name and Position | Heather Anne Reardon-nabbefeld (COUNSELOR) |
| Authorized Official Contact | 9204708359 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1 Bank Ave Kaukauna WI 54130-2581 Ph: (920) 470-8359 | 1 Bank Ave Kaukauna WI 54130-2581 Ph: (920) 470-8359 |
| NPI Number | 1760913362 |
|---|---|
| Provider Enumeration Date | 03/24/2017 |
| Last Update Date | 03/24/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760913362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 6018-125 (Wisconsin) | Primary |
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