Healthcare Provider Details

I. General information

NPI: 1225488943
Provider Name (Legal Business Name): KATIE TOELLNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 COUNTY ROAD DF
JUNEAU WI
53039-9512
US

IV. Provider business mailing address

199 COUNTY ROAD DF
JUNEAU WI
53039-9512
US

V. Phone/Fax

Practice location:
  • Phone: 920-386-3510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2989-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: