Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4813-125 | WI |
NPI | 1003246943 |
---|---|
Provider Name | Jacquelyn Rupnik |
First Address | Elkhorn, WI 53121-4338 |
Second Address | Elkhorn, WI 53121-4338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2013 |
Last Update Date | 13/11/2013 |