Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 5997-125 | WI |
NPI | 1003279753 |
---|---|
Provider Name | Ms. Maria Gloria Vercimak |
First Address | Appleton, WI 54914-5715 |
Second Address | Appleton, WI 54914-5715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 18/09/2018 |