Healthcare Provider Details

I. General information

NPI: 1356884084
Provider Name (Legal Business Name): EMOGENE FLEGNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMOGENE MARINCIC

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 N GRAND AVE STE 302
WAUKESHA WI
53186-4841
US

IV. Provider business mailing address

N64W28295 RUBY CIR
HARTLAND WI
53029-9660
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 262-533-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6285-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: