Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 12058 | WI |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1950 | WI |
NPI | 1003830910 |
---|---|
Provider Name | Karen Young |
First Address | Brookfield, WI 53045-6102 |
Second Address | Hartland, WI 53029-2014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39367300 | (05) | WI |