Healthcare Provider Details

I. General information

NPI: 1962336933
Provider Name (Legal Business Name): EMILY BREISTER LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W EDISON AVE STE 246
APPLETON WI
54915-7807
US

IV. Provider business mailing address

712 SUMMIT AVE
OCONOMOWOC WI
53066-3827
US

V. Phone/Fax

Practice location:
  • Phone: 262-226-2006
  • Fax:
Mailing address:
  • Phone: 262-226-2006
  • Fax: 262-226-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9010-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: