Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4750-125 | WI |
NPI | 1003276072 |
---|---|
Provider Name | Craig Linzmeier |
First Address | Green Bay, WI 54307-3156 |
Second Address | De Pere, WI 54115-9556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2016 |
Last Update Date | 03/03/2016 |