Individual
SAMANTHA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2842 S BUSINESS DR, SHEBOYGAN, WI 53081-6518
(920) 458-6527
Mailing address
1310 22ND ST, TWO RIVERS, WI 54241-2649
(920) 629-7043
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16682-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100013852
—
WI
Enumeration date
07/06/2016
Last updated
07/06/2016
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