Healthcare Provider Details

I. General information

NPI: 1760791289
Provider Name (Legal Business Name): LINN MARY VISSCHER MA LPC LMFT SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N OLD WORLD 3RD ST SUITE 410
MILWAUKEE WI
53203-1100
US

IV. Provider business mailing address

1110 N OLD WORLD 3RD ST SUITE 410
MILWAUKEE WI
53203-1100
US

V. Phone/Fax

Practice location:
  • Phone: 414-690-0891
  • Fax:
Mailing address:
  • Phone: 414-690-0891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17048-130
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number976-226
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4956-125
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number201-228
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number963-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: