Individual
ANNA R FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSSW, LCSW
Contact information
Practice address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(920) 787-5514
Mailing address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(920) 787-5514
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6573-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39797500
—
WI
Enumeration date
05/13/2006
Last updated
06/13/2024
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