Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 10303-132 | WI |
N | 101YP2500X | Professional Counselor | 1236-125 | WI |
NPI | 1003942632 |
---|---|
Provider Name | Mr. Leslie Harold Prausa |
First Address | Oconomowoc, WI 53066-2807 |
Second Address | Elm Grove, WI 53122-2657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |