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General NPI Number Information
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NPI Number | 1609354166
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Entity Type | Individual
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Provider Name | PHOENIX VAN LAANEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 300 CROOKS ST
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City | GREEN BAY
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State | WI
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Zip | 54301-4527
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Country | US
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Telephone | 920-436-6800
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Fax | 920-432-5966
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Provider Business Mailing Address
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Address Line | 2252 EASTMAN AVE
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City | GREEN BAY
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State | WI
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Zip | 54302-4674
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Country | US
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Telephone | 920-680-4073
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 10207
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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 | 10207
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License Number State | WI
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