Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4989-125 | WI |
N | 101YP2500X | Professional Counselor | 585-226 | WI |
NPI | 1003051152 |
---|---|
Provider Name | Louise Clara Daul |
First Address | Green Bay, WI 54303-2831 |
Second Address | Green Bay, WI 54303-2831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2008 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100001242 | (05) | WI |