Annette Pullen, LADC AND LPCC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

01151 Issued in MN

Practice address

15561 Railroad St Ste 203a
Hayward, WI 54843-5703

Phone

(651) 347-1380

Fax

(651) 347-1380

NPI assigned

Feb 28, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1821338765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N9705 VIOLET LN",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548431179",
            "telephone_number": "651-380-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15561 RAILROAD ST STE 203A",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548435703",
            "telephone_number": "651-347-1380",
            "fax_number": "651-347-1380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N9705 Violet Ln",
            "address_purpose": "LOCATION",
            "city": "Hayward",
            "state": "WI",
            "postal_code": "548431179",
            "country_code": "US",
            "telephone_number": "651-347-1380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PULLEN",
        "first_name": "ANNETTE",
        "credential": "LADC AND LPCC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-28",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302869",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "10255-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "01151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodell Rae Petit, APSW, CSAC, ICS
• Melanie Peyton, PTA
• Sara Fern Poquette, APSW
• Connie J Powers
• Premise Health of Wisconsin Medical SC (LP - Hayward)
• Dawn Marcel Quaderer, RN
• Roxie Lynn Quaderer
• Jessica Renea Rands, APNP
• Realign and Reclamation, LLC
• Renew Your Mind - Counseling Consulting and Supervision LLC

• Professional Counselor in Hayward, WI
• Providers in Hayward, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.