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General NPI Number Information
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NPI Number | 1992459408
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Entity Type | Organization
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Legal Business Name | WELLNESS PATH COUNSELING, LLC
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 404 N MAIN ST STE 503
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City | OSHKOSH
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State | WI
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Zip | 54901-4952
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Country | US
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Telephone | 920-937-0115
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Fax |
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Provider Business Mailing Address
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Address Line | 1037 CARRIAGE LN
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City | FOND DU LAC
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State | WI
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Zip | 54935-6556
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Country | US
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Telephone | 920-428-4298
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | STACY BAMBERG
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Credential | LCSW
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Telephone | 920-428-4298
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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 |
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License Number State |
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