Healthcare Provider Details

I. General information

NPI: 1073241816
Provider Name (Legal Business Name): PAKOU THAO APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 DEVELOPMENT DR
GREEN BAY WI
54311-4246
US

IV. Provider business mailing address

2563 DEVELOPMENT DR
GREEN BAY WI
54311-4246
US

V. Phone/Fax

Practice location:
  • Phone: 414-465-9708
  • Fax:
Mailing address:
  • Phone: 920-600-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12344123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: