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General NPI Number Information
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NPI Number | 1568776979
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Entity Type | Individual
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Provider Name | NANCY ANN FENNEMA MSSW
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Gender | Female
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 1825 RIVERSIDE DR
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City | GREEN BAY
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State | WI
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Zip | 54301-2316
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Country | US
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Telephone | 920-272-8234
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Fax | 920-437-4067
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Provider Business Mailing Address
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Address Line | 1825 RIVERSIDE DR
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City | GREEN BAY
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State | WI
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Zip | 54301-2316
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Country | US
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Telephone | 920-272-8234
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Fax | 920-437-4067
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1886-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1999-123
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License Number State | WI
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