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General NPI Number Information
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NPI Number | 1699956607
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Entity Type | Organization
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Legal Business Name | COOPERATIVE EDUCATIONAL SERVICE AGENCY NO 8
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 223 W PARK STREET
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City | GILLETT
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State | WI
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Zip | 54124
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Country | US
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Telephone | 920-855-2114
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Fax | 920-855-2299
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Provider Business Mailing Address
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Address Line | 223 W PARK STREET
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City | GILLETT
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State | WI
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Zip | 54124
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Country | US
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Telephone | 920-855-2114
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Fax | 920-855-2299
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Authorized Official
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Title or Position | AGENCY ADMINISTRATOR
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Name | DR. DONALD J VIEGUT
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Credential | PHD
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Telephone | 920-855-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3675-125
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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 | 3840-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 970-57
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | WI
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