Healthcare Provider Details

I. General information

NPI: 1497274591
Provider Name (Legal Business Name): PAUL DAVID WORKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W SHELL CREEK RD
MINONG WI
54859-9302
US

IV. Provider business mailing address

13380 W TREPANIA RD
HAYWARD WI
54843-2186
US

V. Phone/Fax

Practice location:
  • Phone: 715-466-2201
  • Fax:
Mailing address:
  • Phone: 715-638-5105
  • Fax: 715-634-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3651-226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8268-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: