Healthcare Provider Details

I. General information

NPI: 1679071492
Provider Name (Legal Business Name): ADDIE MAE CALDWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W2372 WOLF RIVER DRIVE
KESHENA WI
54135
US

IV. Provider business mailing address

W2372 WOLF RIVER DRIVE
KESHENA WI
54135
US

V. Phone/Fax

Practice location:
  • Phone: 715-799-3861
  • Fax: 715-799-3517
Mailing address:
  • Phone: 715-799-3861
  • Fax: 715-799-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8185-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: