MEDICARE: EMILY BULTHUIS

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	101YP2500X	Professional Counselor	8753226	WI

General Provider Information

NPI Number	:	1144196056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY BULTHUIS

Provider Business Mailing Address
First Line	:	3166 S AUSTIN ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2604
Country	:	US
Telephone Number	:	708-738-5057
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W VIRGINIA ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1549
Country	:	US
Telephone Number	:	414-502-9067
Fax Number	:

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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Directions to “ EMILY BULTHUIS ” Practice Location

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