Healthcare Provider Details

I. General information

NPI: 1700287802
Provider Name (Legal Business Name): ANNE REPACI MS CRC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13762 W HONEY LN
NEW BERLIN WI
53151-2550
US

IV. Provider business mailing address

13762 W HONEY LN
NEW BERLIN WI
53151-2550
US

V. Phone/Fax

Practice location:
  • Phone: 414-379-3963
  • Fax:
Mailing address:
  • Phone: 414-379-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4621-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: