Healthcare Provider Details

I. General information

NPI: 1659779148
Provider Name (Legal Business Name): RENA ANN CROSS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENA A STOEGBAUER LPC-T

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 RED WOLF TRL
BLUE MOUNDS WI
53517-9717
US

IV. Provider business mailing address

2905 RED WOLF TRL
BLUE MOUNDS WI
53517-9717
US

V. Phone/Fax

Practice location:
  • Phone: 608-289-6436
  • Fax:
Mailing address:
  • Phone: 608-289-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6056-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: