MEDICARE: MS. LAURIE LYNN NELSON 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	101YP2500X	Professional Counselor	5919-125	WI

General Provider Information

NPI Number	:	1801360730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE LYNN NELSON LPC

Provider Business Mailing Address
First Line	:	8801 W OKLAHOMA AVE APT 305
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53227-4571
Country	:	US
Telephone Number	:	414-469-4951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 N 7TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1701
Country	:	US
Telephone Number	:	414-265-6360
Fax Number	:	414-265-8151

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	01/14/2019

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