MEDICARE: KATHERINE A DEBRUIN 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	2294-226	WI
2	101YP2500X	Professional Counselor	6118-125	WI
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	17178-130	WI
4	101YP2500X	Professional Counselor	6118	WI

General Provider Information

NPI Number	:	1851773105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE A DEBRUIN LPC

Provider Business Mailing Address
First Line	:	W6240 COMMUNICATION CT STE 2
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-8549
Country	:	US
Telephone Number	:	920-364-0747
Fax Number	:

Provider Business Practice Location Address
First Line	:	W6240 COMMUNICATION CT STE 2
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-8549
Country	:	US
Telephone Number	:	920-364-0747
Fax Number	:

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

Provider Enumeration Date	:	06/23/2015
Last Update Date	:	02/02/2026

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