Healthcare Provider Details

I. General information

NPI: 1043109697
Provider Name (Legal Business Name): JACQUELINE DENEEN BUHS CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11117 KERN LN.
ARBOR VITAE WI
54568
US

IV. Provider business mailing address

PO BOX 1871
WOODRUFF WI
54568-1871
US

V. Phone/Fax

Practice location:
  • Phone: 715-358-6900
  • Fax:
Mailing address:
  • Phone: 715-358-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3837-046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: