Individual
BETHANY PANKRATZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
821 E 1ST AVE STE 5, APPLETON, WI 54911-1586
(920) 659-0180
Mailing address
N1398 FAIRWINDS DR, GREENVILLE, WI 54942-8052
(920) 659-0180
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5244-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85-1521984
IRS
WI
Enumeration date
02/24/2022
Last updated
02/24/2022
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