Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | WI |
NPI | 1003271693 |
---|---|
Provider Name | Ms. Ashley Elizabeth Birkholz |
First Address | West Bend, WI 53095-8533 |
Second Address | West Bend, WI 53095-8533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2015 |
Last Update Date | 23/12/2015 |