Healthcare Provider Details

I. General information

NPI: 1417370461
Provider Name (Legal Business Name): ELLEN M DAUBERT MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E794 RIVERVIEW LN
GENOA WI
54632-8705
US

IV. Provider business mailing address

E794 RIVERVIEW LANE GENOA WI
GENOA WI
54632
US

V. Phone/Fax

Practice location:
  • Phone: 606-087-8049
  • Fax:
Mailing address:
  • Phone: 608-780-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5452-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: