MEDICARE: EMILY ANN MERTENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	400-228	WI

General Provider Information

NPI Number	:	1023406899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANN MERTENS

Provider Business Mailing Address
First Line	:	5001 SHEBOYGAN AVE APT 113
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-2808
Country	:	US
Telephone Number	:	414-651-0712
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 SHEBOYGAN AVE APT 113
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-2808
Country	:	US
Telephone Number	:	414-651-0712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2015
Last Update Date	:	01/02/2015

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