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General NPI Number Information
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NPI Number | 1073659801
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Entity Type | Individual
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Provider Name | JEFFREY KARL BUIKEMA PHD, LPC
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 201 MAIN ST STE 500
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City | LA CROSSE
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State | WI
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Zip | 54601-0716
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Country | US
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Telephone | 608-668-4005
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Fax | 608-668-4006
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW STE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1789
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Country | US
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Telephone | 651-628-9566
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Fax | 651-628-0411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 229-124
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4262
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License Number State | WI
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