Healthcare Provider Details

I. General information

NPI: 1821089988
Provider Name (Legal Business Name): JEANETTE PIEPER BSW, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 W POINT RD
GREEN BAY WI
54304-1344
US

IV. Provider business mailing address

PO BOX 365
ONEIDA WI
54155-0365
US

V. Phone/Fax

Practice location:
  • Phone: 920-869-2711
  • Fax:
Mailing address:
  • Phone: 920-869-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2151-132
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2151
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: