Healthcare Provider Details

I. General information

NPI: 1053643403
Provider Name (Legal Business Name): MELANIE STRAND-GLATCZAK CSAC. LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE STRAND CSAC

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S 36TH AVE
WAUSAU WI
54401-3930
US

IV. Provider business mailing address

1493 COUNTY RD Q
HATLEY WI
54440
US

V. Phone/Fax

Practice location:
  • Phone: 715-842-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15420-130
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7723
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: