Healthcare Provider Details

I. General information

NPI: 1336575166
Provider Name (Legal Business Name): LISA A PLOESSL BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SAINT ANDREW ST STE 100
LA CROSSE WI
54603-2378
US

IV. Provider business mailing address

910 DEERFIELD ST
HOLMEN WI
54636-9482
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-6262
  • Fax:
Mailing address:
  • Phone: 608-526-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number8396120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: