Natalie Cornelius, 15990132 CSAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Gresham, WI
NPI 1962867085 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1962867085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 15990-132 (WI)
- Practice address
- N2150 Kesaehkahtek Rd
Gresham, WI 54128-9602 - Phone
- (715) 799-3835
- NPI assigned
- Dec 16, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15990-132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15990-132 | WI | Yes |
Addresses
Primary practice location
N2150 Kesaehkahtek Rd
Gresham, WI 54128-9602
Mailing address
N7988 Huntington Rd
Gresham, WI 54128
Phone (715) 851-5453
Other practice location 1
2979 Allied St
Green Bay, WI 54304-5567
Phone (920) 337-6740
Other providers in Gresham, WI
- Mary Bernadette Barney
- Ronaele M Clasen
- Gresham School District
- Ashley Hebert
- Dominic David Hermann
- Teresa Jean Juga
- Brian A Krause
All providers in Gresham, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.