MEDICARE: EMILY M EBBEN LPC

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	6865-125	WI
2	101YP2500X	Professional Counselor	3094-226	WI

General Provider Information

NPI Number	:	1336592120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY M EBBEN LPC

Provider Business Mailing Address
First Line	:	444 N WESTHILL BLVD
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-5715
Country	:	US
Telephone Number	:	920-735-7480
Fax Number	:	920-364-2415

Provider Business Practice Location Address
First Line	:	1595 ALLOUEZ AVE.
Second Line	:	SUITE 3
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5639
Country	:	US
Telephone Number	:	920-214-5844
Fax Number	:

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

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	03/25/2026

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