MEDICARE: LEELLEN KAYE CARTER CSAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	A8420912	CA

General Provider Information

NPI Number	:	1609115971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEELLEN KAYE CARTER CSAC

Provider Business Mailing Address
First Line	:	306 MILTON AVE
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3152
Country	:	US
Telephone Number	:	608-481-4475
Fax Number	:

Provider Business Practice Location Address
First Line	:	5109 WORLD DAIRY DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53718-3807
Country	:	US
Telephone Number	:	608-242-0220
Fax Number	:

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

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	09/28/2022

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