Healthcare Provider Details

I. General information

NPI: 1750528360
Provider Name (Legal Business Name): DAVID W. PALUCH RN, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 S MONROE AVE
GREEN BAY WI
54301-3002
US

IV. Provider business mailing address

1208 S MONROE AVE
GREEN BAY WI
54301-3002
US

V. Phone/Fax

Practice location:
  • Phone: 920-327-2596
  • Fax:
Mailing address:
  • Phone: 920-327-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4114-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number102610
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: