Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 16144-131 | WI |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 17387-130 | WI |
N | 101YP2500X | Professional Counselor | 1345-266 | WI |
Y | 101YP2500X | Professional Counselor | 5992-125 | WI |
NPI | 1003200692 |
---|---|
Provider Name | Courtney M Quast |
First Address | Fort Atkinson, WI 53538-0249 |
Second Address | Fort Atkinson, WI 53538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 08/09/2017 |