Healthcare Provider Details

I. General information

NPI: 1013872134
Provider Name (Legal Business Name): JADE COUNTY COMMUNITY TRE PIRLOTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 GERSHWIN DR
GREEN BAY WI
54311-4328
US

IV. Provider business mailing address

3150 GERSHWIN DR
GREEN BAY WI
54311-4328
US

V. Phone/Fax

Practice location:
  • Phone: 920-391-4700
  • Fax: 920-391-4731
Mailing address:
  • Phone: 920-391-4700
  • Fax: 920-391-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8783
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: