Healthcare Provider Details

I. General information

NPI: 1700744026
Provider Name (Legal Business Name): CRYSTAL R PLUMB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 N WESTHILL BLVD STE A
APPLETON WI
54914-6532
US

IV. Provider business mailing address

37 19TH ST
CLINTONVILLE WI
54929-1131
US

V. Phone/Fax

Practice location:
  • Phone: 877-300-9101
  • Fax:
Mailing address:
  • Phone: 715-250-0675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8855-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: