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General NPI Number Information
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NPI Number | 1134901150
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Entity Type | Organization
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Legal Business Name | CLINE COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 7151 EVERGREEN AVE
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-9587
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Country | US
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Telephone | 920-454-0314
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Fax |
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Provider Business Mailing Address
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Address Line | 7151 EVERGREEN AVE
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-9587
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA CLINE
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Credential |
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Telephone | 920-454-0314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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