Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 18178-130 | WI |
Y | 101YP2500X | Professional Counselor | 7631-25 | WI |
NPI | 1003314907 |
---|---|
Provider Name | Kiersten Lynette Buck |
First Address | Eau Claire, WI 54701-9084 |
Second Address | Eau Claire, WI 54701-9084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2018 |
Last Update Date | 07/07/2021 |