| NPI | 1194036228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN MARIE ROSS Therapist 920-819-2914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 3898-125) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2010-06-23 |