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NPI Code Detail

MEDICARE: MARI J KRIESCHER MS,LPC,CSAC,ICS

MEDICARE: MARI J KRIESCHER MS,LPC,CSAC,ICS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor11704-132WI
21041C0700XClinical Social Worker11704WI
3101YP2500XProfessional Counselor4693-125WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629068192
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARI J KRIESCHER MS,LPC,CSAC,ICS
Provider Business Mailing Address
First Line : PO BOX 365
Second Line :
City : ONEIDA
State : WI
Zip : 54155-0365
Country : US
Telephone Number : 920-896-2711
Fax Number :
Provider Business Practice Location Address
First Line : 2640 W POINT RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-1344
Country : US
Telephone Number : 920-869-2711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 01/21/2021

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