Healthcare Provider Details

I. General information

NPI: 1104276195
Provider Name (Legal Business Name): ANNA J SZYPEREK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA GIRDAUSKAS LPC-IT

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N. WESTHILL BLVD
APPLETON WI
54914-5715
US

IV. Provider business mailing address

444 N WESTHILL BLVD
APPLETON WI
54914-5715
US

V. Phone/Fax

Practice location:
  • Phone: 920-750-7000
  • Fax: 920-364-2451
Mailing address:
  • Phone: 920-735-7480
  • Fax: 920-364-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3093-226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6904
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: