Healthcare Provider Details

I. General information

NPI: 1518627991
Provider Name (Legal Business Name): ANNE-MARIE E NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 SPRUCE CT
OCONOMOWOC WI
53066-9313
US

IV. Provider business mailing address

1095 SPRUCE CT
OCONOMOWOC WI
53066-9313
US

V. Phone/Fax

Practice location:
  • Phone: 262-443-9329
  • Fax:
Mailing address:
  • Phone: 262-443-9329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.016453
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00016147
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: