Healthcare Provider Details

I. General information

NPI: 1336388388
Provider Name (Legal Business Name): CORIENE MARIE PLOETZ M.S., N.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CORIENE MARIE ROBBINS

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 02/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N RANDALL AVE SUITE A
JANESVILLE WI
53545-1958
US

IV. Provider business mailing address

612 N RANDALL AVE SUITE A
JANESVILLE WI
53545-1958
US

V. Phone/Fax

Practice location:
  • Phone: 608-752-7660
  • Fax: 608-752-9788
Mailing address:
  • Phone: 608-752-7660
  • Fax: 608-752-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number55-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: