Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2875-226 | WI |
NPI | 1003274770 |
---|---|
Provider Name | Annelies Luellen White |
First Address | Menomonie, WI 54751-2313 |
Second Address | Menomonie, WI 54751-2313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2016 |
Last Update Date | 25/03/2020 |