Healthcare Provider Details

I. General information

NPI: 1801530035
Provider Name (Legal Business Name): DOUGLAS S RAMICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W. FIRST ST STE 270
NEW RICHMOND WI
54017-1770
US

IV. Provider business mailing address

105 W. FIRST ST STE 270
NEW RICHMOND WI
54017-1770
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-4840
  • Fax: 715-254-9459
Mailing address:
  • Phone: 715-246-4840
  • Fax: 715-254-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2137
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: