Healthcare Provider Details

I. General information

NPI: 1548475833
Provider Name (Legal Business Name): CHELSEA L BAUCOM-YOUNG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 S MORRISON ST
APPLETON WI
54911-5725
US

IV. Provider business mailing address

8007 EXCELSIOR DR
MADISON WI
53717-1903
US

V. Phone/Fax

Practice location:
  • Phone: 920-832-2783
  • Fax:
Mailing address:
  • Phone: 608-829-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number126890
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: