Healthcare Provider Details

I. General information

NPI: 1013285006
Provider Name (Legal Business Name): KATIE L BRUEGGEN MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 06/17/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S 36TH AVE
WAUSAU WI
54401-3930
US

IV. Provider business mailing address

630 S 36TH AVE
WAUSAU WI
54401-3930
US

V. Phone/Fax

Practice location:
  • Phone: 855-607-8242
  • Fax:
Mailing address:
  • Phone: 855-607-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number891-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: