Healthcare Provider Details

I. General information

NPI: 1407001662
Provider Name (Legal Business Name): KRAWCZYK COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 PACKERLAND DR SUITE 104C
GREEN BAY WI
54313-4130
US

IV. Provider business mailing address

PO BOX 25
DE PERE WI
54115-0025
US

V. Phone/Fax

Practice location:
  • Phone: 920-965-7701
  • Fax: 920-497-4956
Mailing address:
  • Phone: 920-983-9401
  • Fax: 920-983-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6723-123
License Number StateWI

VIII. Authorized Official

Name: GAIL KRAWCZYK
Title or Position: PRESIDENT
Credential:
Phone: 920-965-7701