Healthcare Provider Details

I. General information

NPI: 1225005887
Provider Name (Legal Business Name): L & D ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 W MAIN ST SUITE 6
SUN PRAIRIE WI
53590-1846
US

IV. Provider business mailing address

1460 W MAIN ST SUITE 6
SUN PRAIRIE WI
53590-1846
US

V. Phone/Fax

Practice location:
  • Phone: 608-837-4814
  • Fax: 608-825-4933
Mailing address:
  • Phone: 608-837-4814
  • Fax: 608-825-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1742
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1742
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1742
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1742
License Number StateWI

VIII. Authorized Official

Name: MS. CATHRYN HUBBARD
Title or Position: MANAGER
Credential:
Phone: 608-837-4814