Healthcare Provider Details

I. General information

NPI: 1356668024
Provider Name (Legal Business Name): NOEL L'ESPERANCE DAT, ATR-BC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E SILVER SPRING DR # 2FE
GLENDALE WI
53217-5222
US

IV. Provider business mailing address

324 E SILVER SPRING DR # 2FE
GLENDALE WI
53217-5221
US

V. Phone/Fax

Practice location:
  • Phone: 920-379-2566
  • Fax:
Mailing address:
  • Phone: 920-379-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4921
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: