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General NPI Number Information
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NPI Number | 1174857312
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Entity Type | Organization
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Legal Business Name | RURAL EMPLOYEE AND STUDENT ASSISTANCE PROFESSIONALS, INC.
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 40 JEWELERS PARK DRIVE SUITE 100
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City | NEENAH
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State | WI
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Zip | 54956
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Country | US
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Telephone | 715-281-1541
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Fax | 920-720-9980
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Provider Business Mailing Address
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Address Line | 40 JEWELERS PARK DR SUITE 100
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City | NEENAH
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State | WI
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Zip | 54956-3702
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Country | US
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Telephone | 715-281-1541
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Fax | 920-720-9980
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. LAURIE ANN KNUTZEN
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Credential | M.S.S.W.
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Telephone | 715-281-1541
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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 | 625-123
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License Number State | WI
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