Healthcare Provider Details

I. General information

NPI: 1336043769
Provider Name (Legal Business Name): JOSIAH ELKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

340 N BROADWAY STE 260
GREEN BAY WI
54303-2825
US

IV. Provider business mailing address

340 N BROADWAY STE 260
GREEN BAY WI
54303-2825
US

V. Phone/Fax

Practice location:
  • Phone: 920-370-9545
  • Fax: 920-393-3819
Mailing address:
  • Phone: 920-370-9545
  • Fax: 920-393-3819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8888-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: