MEDICARE: PAULINE ANN PREUSS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3467-125	WI

General Provider Information

NPI Number	:	1417955774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE ANN PREUSS MA

Provider Business Mailing Address
First Line	:	290 17TH ST
Second Line	:
City	:	FOND DU LAC
State	:	WI
Zip	:	54935-6066
Country	:	US
Telephone Number	:	920-924-9359
Fax Number	:	920-924-9359

Provider Business Practice Location Address
First Line	:	6944 W FOREST HOME AVE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-2917
Country	:	US
Telephone Number	:	262-719-3825
Fax Number	:	414-321-8588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/08/2007

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