Healthcare Provider Details

I. General information

NPI: 1699412148
Provider Name (Legal Business Name): CALLIE PAUC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SUMMIT AVE
OCONOMOWOC WI
53066-3827
US

IV. Provider business mailing address

712 SUMMIT AVE
OCONOMOWOC WI
53066-3827
US

V. Phone/Fax

Practice location:
  • Phone: 262-226-2462
  • Fax:
Mailing address:
  • Phone: 262-226-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: