Healthcare Provider Details

I. General information

NPI: 1275809352
Provider Name (Legal Business Name): A SINGLE STEP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E 1ST AVE STE 5
APPLETON WI
54911-1586
US

IV. Provider business mailing address

821 E 1ST AVE STE 5
APPLETON WI
54911-1586
US

V. Phone/Fax

Practice location:
  • Phone: 920-265-2286
  • Fax:
Mailing address:
  • Phone: 920-265-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4615-125
License Number StateWI

VIII. Authorized Official

Name: JANE WISNESKI
Title or Position: OWNER/LICENSED PROFESSIONAL COUNSEL
Credential: LPC
Phone: 920-265-2286