Healthcare Provider Details

I. General information

NPI: 1356994115
Provider Name (Legal Business Name): REBECCA MARY STELLA KUCINSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 09/16/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST W
ASHLAND WI
54806-1639
US

IV. Provider business mailing address

300 MAIN ST W
ASHLAND WI
54806-1639
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-2200
  • Fax:
Mailing address:
  • Phone: 715-685-2200
  • Fax: 715-685-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7931-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: