Healthcare Provider Details

I. General information

NPI: 1144757394
Provider Name (Legal Business Name): LAURIE ANN RECHEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE ANN BUSSE CSW

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 PARKSIDE ST
RIPON WI
54971-8505
US

IV. Provider business mailing address

845 PARKSIDE ST
RIPON WI
54971-8505
US

V. Phone/Fax

Practice location:
  • Phone: 920-926-4200
  • Fax: 920-926-8914
Mailing address:
  • Phone: 920-926-4200
  • Fax: 920-926-8914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9332-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: