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General NPI Number Information
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NPI Number | 1831847235
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Entity Type | Individual
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Provider Name | CLAIRISSA VOUGA LAC
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Gender | Female
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 3278 MAIN ST
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City | EAST TROY
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State | WI
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Zip | 53120-1152
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Country | US
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Telephone | 262-853-6129
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Fax |
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Provider Business Mailing Address
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Address Line | W334S5310 RED FOX WAY
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City | NORTH PRAIRIE
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State | WI
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Zip | 53153-9739
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Country | US
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Telephone | 262-853-6129
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1015-55
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License Number State | WI
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