Healthcare Provider Details

I. General information

NPI: 1396129755
Provider Name (Legal Business Name): AIMEE BUDLESKI MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 ROSS AVE STE 107
SCHOFIELD WI
54476-6110
US

IV. Provider business mailing address

219 ROSS AVE STE 107
SCHOFIELD WI
54476-6110
US

V. Phone/Fax

Practice location:
  • Phone: 715-297-5050
  • Fax: 800-688-6286
Mailing address:
  • Phone: 715-297-5050
  • Fax: 800-688-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6301-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2511
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number645378
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: