Healthcare Provider Details

I. General information

NPI: 1528297470
Provider Name (Legal Business Name): JULIE FEIDER, MSE, LPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W NORTH WATER ST
NEW LONDON WI
54961-1249
US

IV. Provider business mailing address

PO BOX 26
DE PERE WI
54115-0026
US

V. Phone/Fax

Practice location:
  • Phone: 920-982-2289
  • Fax: 920-982-2888
Mailing address:
  • Phone: 920-983-9401
  • Fax: 920-983-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3681125
License Number StateWI

VIII. Authorized Official

Name: JULIE FEIDER
Title or Position: OWNER
Credential: MSE, LPC
Phone: 920-982-2289