Healthcare Provider Details

I. General information

NPI: 1235878026
Provider Name (Legal Business Name): ELLEN FLOATE SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 S 8TH ST
MANITOWOC WI
54220-4535
US

IV. Provider business mailing address

926 S 8TH ST
MANITOWOC WI
54220-4535
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-4230
  • Fax: 920-683-4908
Mailing address:
  • Phone: 920-683-4230
  • Fax: 920-683-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19719-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: