Healthcare Provider Details

I. General information

NPI: 1710707674
Provider Name (Legal Business Name): PATRICIA ANN DEMPSEY LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S ONEIDA ST
APPLETON WI
54915-1351
US

IV. Provider business mailing address

2636 S GLADYS AVE
APPLETON WI
54915-2570
US

V. Phone/Fax

Practice location:
  • Phone: 920-903-8841
  • Fax: 920-268-1863
Mailing address:
  • Phone: 920-716-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8175-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: