Individual
JAIMIE SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC, LPC
Contact information
Practice address
300 CROOKS ST, GREEN BAY, WI 54301-4527
(920) 436-6800
(920) 432-5966
Mailing address
300 CROOKS ST, GREEN BAY, WI 54301-4527
(920) 436-6800
(920) 432-5966
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15801-131
WI
101YP2500X
Professional Counselor
Primary
5130-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265721161
—
WI
Enumeration date
03/31/2011
Last updated
03/10/2014
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