Individual
MR. MARK R EKLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW,MFT
Contact information
Practice address
1325 ANGELS PATH RD, DE PERE, WI 54115-4050
(920) 338-2855
(920) 338-9270
Mailing address
PO BOX 22040, GREEN BAY, WI 54305-2040
(920) 445-7226
(920) 445-7229
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1501-123
WI
106H00000X
Marriage & Family Therapist
485-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39342800
—
WI
Enumeration date
08/12/2006
Last updated
04/10/2019
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