Healthcare Provider Details

I. General information

NPI: 1962889436
Provider Name (Legal Business Name): CARISSA WEBER LPC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7387 LOGERQUIST RD
BAILEYS HARBOR WI
54202-9610
US

IV. Provider business mailing address

7387 LOGERQUIST RD
BAILEYS HARBOR WI
54202-9610
US

V. Phone/Fax

Practice location:
  • Phone: 715-451-7530
  • Fax: 715-848-8665
Mailing address:
  • Phone: 715-451-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15875-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5464-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: