Healthcare Provider Details

I. General information

NPI: 1265015473
Provider Name (Legal Business Name): ANA KARINA CUELLAR-MONTES APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E FOUNTAIN ST
DODGEVILLE WI
53533-1749
US

IV. Provider business mailing address

165 W NETHERWOOD ST STE A
OREGON WI
53575-1107
US

V. Phone/Fax

Practice location:
  • Phone: 608-835-5050
  • Fax: 608-835-5010
Mailing address:
  • Phone: 608-835-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132287-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: